Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 025734 | NY |
NPI | 1043752330 |
---|---|
Provider Name | Mrs. Stephanie Pollak |
First Address | Queensbury, NY 12804-7880 |
Second Address | Queensbury, NY 12804-7880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2016 |
Last Update Date | 17/11/2016 |