Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1033568720 |
---|---|
Provider Name | Mrs. Mary Bice |
First Address | Fort Drum, NY 13602-5005 |
Second Address | Fort Drum, NY 13602-5005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2016 |
Last Update Date | 03/06/2016 |