Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | A8428 | MN |
N | 126800000X | Dental Assistant | A8428 | MN |
NPI | 1114451150 |
---|---|
Provider Name | Miss Vicki Marie Schwartz |
First Address | Woodbury, MN 55125 |
Second Address | Woodbury, MN 55125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2017 |
Last Update Date | 17/04/2017 |