Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1306350434 |
---|---|
Provider Name | Ms. Lashette Marie Jordan |
First Address | Apo, AE 09114-0078 |
Second Address | Apo, AE 09114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 07/11/2019 |