Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1184223844 |
---|---|
Provider Name | Ms. Cindy Mccourt |
First Address | Dallas, TX 75243-7159 |
Second Address | Dallas, TX 75243-7159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2020 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11226 | LICENSE (01) | TX |