Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 33564 | CA |
NPI | 1013117480 |
---|---|
Provider Name | Mrs. Gail Diane Cox |
First Address | Beaumont, CA 92223-8038 |
Second Address | Beaumont, CA 92223-8038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 23/07/2007 |