Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | EFDA. 00309 | OH |
NPI | 1023439023 |
---|---|
Provider Name | Mrs. Tricia Marie Waddell |
First Address | Cincinnati, OH 45229 |
Second Address | Cincinnati, OH 45229-3014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2013 |
Last Update Date | 18/12/2013 |