Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 10443 | TN |
NPI | 1225113582 |
---|---|
Provider Name | Miss Lori Jae Vann |
First Address | Winchester, TN 37398-4527 |
Second Address | Franklin, TN 37067-8290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |