Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | KY4316 | KY |
NPI | 1063460046 |
---|---|
Provider Name | Ms. June Alice Brose |
First Address | Apo Ae, NC 09244 |
Second Address | Apo Ae, NC 09244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |