Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 402 | MD |
NPI | 1043501414 |
---|---|
Provider Name | Mrs. Liguori Anne Tewes |
First Address | Baltimore, MD 21201-1510 |
Second Address | Baltimore, MD 21201-1510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 20/04/2011 |