Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 126800000X | Dental Assistant | SC |
NPI | 1053394387 |
---|---|
Provider Name | Mrs. Mary Joette Mccoy |
First Address | Greenville, SC 29609 |
Second Address | Greenville, SC 29605-4070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 08/07/2007 |