Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1033774674 |
---|---|
Provider Name | Ms. Blythe Noelle Jones |
First Address | Fort Carson, CO 80913-4095 |
Second Address | Fort Carson, CO 80913-4095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2019 |
Last Update Date | 09/05/2019 |