Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 85738 | TX |
NPI | 1053866335 |
---|---|
Provider Name | Mrs. Ugendiesidett Richardson |
First Address | El Paso, TX 79904-4211 |
Second Address | El Paso, TX 79904-4211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2016 |
Last Update Date | 17/08/2016 |