Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3516 | NC |
NPI | 1053713875 |
---|---|
Provider Name | Mrs. Regina Wade |
First Address | Cherokee, NC 28729 |
Second Address | Cherokee, NC 28719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 24/09/2014 |