Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 31.013125 | OH |
NPI | 1023325321 |
---|---|
Provider Name | Ms. Kimberly Sudhoff |
First Address | Lima, OH 45804-2482 |
Second Address | Lima, OH 45804-2482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 08/09/2010 |