Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3173 | ME |
NPI | 1033343546 |
---|---|
Provider Name | Mrs. Jessica M.w. Alexander |
First Address | Augusta, ME 04330 |
Second Address | Augusta, ME 04330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2009 |
Last Update Date | 12/05/2009 |