Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | A10295 | OR |
NPI | 1083726038 |
---|---|
Provider Name | Mrs. Macy M Bienerth |
First Address | Ridgefield, WA 98642-9415 |
Second Address | Vancouver, WA 98684-6053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |