Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | A10621 | MN |
NPI | 1164528170 |
---|---|
Provider Name | Miss Melissa Raye Harrington |
First Address | Cottage Grove, MN 55016-2025 |
Second Address | Woodbury, MN 55125-3910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |