Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 0000054 | NY |
NPI | 1114194396 |
---|---|
Provider Name | Ms. Mary Beth Sojka |
First Address | Lackawanna, NY 14218-1629 |
Second Address | Lackawanna, NY 14218-1629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 15/05/2008 |