Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | CA |
NPI | 1053867903 |
---|---|
Provider Name | Ms. Jacqueline Julian |
First Address | Pooler, GA 31322-2174 |
Second Address | Hunter Army Air Field, GA 31322-4419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 31/08/2016 |