Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6296 | NC |
NPI | 1023141298 |
---|---|
Provider Name | Mrs. Laura G Borzachini |
First Address | Winston Salem, NC 27103-3043 |
Second Address | Winston Salem, NC 27103-3043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6296 | RDH LICENSE # IN NC (01) | NC |