Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 200621 | CO |
NPI | 1013250158 |
---|---|
Provider Name | Ms. Marta Sue Butler-Bearzi |
First Address | Fairplay, CO 80440 |
Second Address | Fairplay, CO 80440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2013 |
Last Update Date | 25/07/2013 |