Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 27009 | CA |
NPI | 1073947198 |
---|---|
Provider Name | Ms. Holly Putt |
First Address | Rancho Cucamonga, CA 91730-8934 |
Second Address | West Covina, CA 91790-2946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2013 |
Last Update Date | 26/08/2013 |