Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4080 | SC |
NPI | 1023776036 |
---|---|
Provider Name | Mrs. Kia Porcher |
First Address | Summerville, SC 29483-5356 |
Second Address | Goose Creek, SC 29445-6314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2021 |
Last Update Date | 07/12/2021 |