Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH009849L | PA |
NPI | 1033323332 |
---|---|
Provider Name | Mrs. Lori Ann Green |
First Address | Emmaus, PA 18049-3303 |
Second Address | Allentown, PA 18049-3303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |