Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH011154 | GA |
NPI | 1033454962 |
---|---|
Provider Name | Miss Melissa Rae Drennon |
First Address | Rapid City, SD 57702-6245 |
Second Address | Rapid City, SD 57702-6245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2012 |
Last Update Date | 04/12/2012 |