Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | RDH8485 | CA |
Y | 124Q00000X | Dental Hygienist | RDHAP86 | CA |
NPI | 1033499249 |
---|---|
Provider Name | Mrs. Caroline Cathleen Dornbush |
First Address | Lodi, CA 95242-2045 |
Second Address | Lodi, CA 95242-2045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2011 |
Last Update Date | 18/08/2011 |