Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 12170 | TX |
NPI | 1013040054 |
---|---|
Provider Name | Mrs. Quiendra Rochelle Simone |
First Address | Frisco, TX 75035-7875 |
Second Address | Allen, TX 75013-6305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |