Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2954 | NH |
NPI | 1053606970 |
---|---|
Provider Name | Mrs. Tina L Carlson |
First Address | South Royalton, VT 05068-0554 |
Second Address | Lebanon, NH 03766-6313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 20/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2954 | RDH (01) | NH |