Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 1776 | CA |
NPI | 1235595638 |
---|---|
Provider Name | Ms. Antoinette Payton |
First Address | South Gate, CA 90280-6167 |
Second Address | South Gate, CA 90280-6167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2016 |
Last Update Date | 14/01/2016 |