Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 031512 | KS |
NPI | 1174573117 |
---|---|
Provider Name | Ms. Diane Loehr |
First Address | El Dorado, KS 67042-3904 |
Second Address | Wichita, KS 67218-1607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |