Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5019 | OR |
NPI | 1083007694 |
---|---|
Provider Name | Mrs. Danielle Godley |
First Address | Central Point, OR 97502-1509 |
Second Address | Central Point, OR 97502-1509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2015 |
Last Update Date | 07/03/2015 |