Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 2903003581 | MI |
NPI | 1316610488 |
---|---|
Provider Name | Ms. Alexandra Myers |
First Address | Canton, MI 48187-3516 |
Second Address | Ann Arbor, MI 48105-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2021 |
Last Update Date | 26/07/2021 |