Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1376798272 |
---|---|
Provider Name | Miss Jennifer Louise Billingsley |
First Address | Marietta, GA 30068-5425 |
Second Address | Marietta, GA 30068-5425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 20/11/2008 |