Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 7173 | MD |
NPI | 1013419639 |
---|---|
Provider Name | Miss Jennifer L Durham |
First Address | Brandywine, MD 20613-3035 |
Second Address | Brandywine, MD 20613-3035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 28/02/2018 |