Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 51018005 | OH |
NPI | 1225431893 |
---|---|
Provider Name | Ms. Brooke Whalen |
First Address | Cincinnati, OH 45238 |
Second Address | Cincinnati, OH 45238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2014 |
Last Update Date | 26/09/2014 |