Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 115716 | OR |
NPI | 1043589641 |
---|---|
Provider Name | Mrs. Jevona N Maniex |
First Address | Madison Heights, MI 48071-3487 |
Second Address | Madison Heights, MI 48071-3487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2011 |
Last Update Date | 30/01/2014 |