Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1174745574 |
---|---|
Provider Name | Mrs. Danielle Marie Wilson |
First Address | Willoughby, OH 44094-5631 |
Second Address | Willoughby, OH 44094-5631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |