Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 85316 | TX |
NPI | 1215494901 |
---|---|
Provider Name | Mrs. Shelby Lauren Bryan |
First Address | Huntington, TX 75949 |
Second Address | Huntington, TX 75949 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2019 |
Last Update Date | 28/02/2019 |