Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH 10220 | FL |
NPI | 1053694679 |
---|---|
Provider Name | Ms. Kelly Ann Langsten |
First Address | Eglin Afb, FL 32542 |
Second Address | Eglin Afb, FL 32542-1302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2011 |
Last Update Date | 20/09/2011 |