Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 31341 | CA |
NPI | 1043364540 |
---|---|
Provider Name | Miss Mary Louise Hunter |
First Address | Sacramento, CA 95817-2207 |
Second Address | Sacramento, CA 95817-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |