Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH.002023812 | CO |
NPI | 1003305376 |
---|---|
Provider Name | Mrs. Tiffny Kuper |
First Address | Chesapeake, VA 23321-6143 |
Second Address | Portsmouth, VA 23708-2111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2018 |
Last Update Date | 02/05/2018 |