Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2205 | ND |
Y | 122300000X | Dentist | 2901022551 | MI |
N | 1223D0001X | Dental Public Health | 2205 | ND |
NPI | 1053696096 |
---|---|
Provider Name | Mrs. Bardha Krasniqi |
First Address | Hudsonville, MI 49426-7651 |
Second Address | Hudsonville, MI 49426-7651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2011 |
Last Update Date | 05/02/2022 |