Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1316195787 |
---|---|
Provider Name | Mrs. Valerie Kay Staples |
First Address | Suwanee, GA 30024-8493 |
Second Address | Suwanee, GA 30024-8493 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 28/08/2008 |