Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 140563 | CT |
NPI | 1366619512 |
---|---|
Provider Name | Mrs. Reina Carolina Garcia |
First Address | New London, CT 06320-8100 |
Second Address | New London, CT 06320-8100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 15/05/2008 |