Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 50128 | CA |
NPI | 1144308339 |
---|---|
Provider Name | Miss Laura M O Farrell |
First Address | Atascadero, CA 93422 |
Second Address | San Luis Obispo, CA 93401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |