Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1063570869 |
---|---|
Provider Name | Mrs. Charyl F Allison |
First Address | Hillsborough, NC 27278-2438 |
Second Address | Carrboro, NC 27510-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07146 | BCBS NC (01) | NC |
3404475 | (05) | NC |