Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 025978 | NY |
NPI | 1023693348 |
---|---|
Provider Name | Mrs. Paula Petrone |
First Address | East Norwich, NY 11732-1225 |
Second Address | East Norwich, NY 11732-1225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2021 |
Last Update Date | 17/03/2021 |