Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA90239 | CA |
NPI | 1265991756 |
---|---|
Provider Name | Mrs. Nakesha Munson |
First Address | Hemet, CA 92545-4743 |
Second Address | Perris, CA 92570-5552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 14/03/2019 |