Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1306055728 |
---|---|
Provider Name | Molly Elaine Smith |
First Address | Graniteville, SC 29829-3528 |
Second Address | Augusta, GA 30912-0012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |