Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 7043 | CA |
NPI | 1013272079 |
---|---|
Provider Name | Ms. Ann P. Adams |
First Address | San Rafael, CA 94901-5716 |
Second Address | San Rafael, CA 94901-5716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 05/07/2012 |