Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 8417 | CA |
N | 124Q00000X | Dental Hygienist | 9203298 | CO |
Y | 124Q00000X | Dental Hygienist | 983 | LA |
NPI | 1063744829 |
---|---|
Provider Name | Ms. Melanie A Clary |
First Address | Apo, AE 09139 |
Second Address | Apo, AE 09112-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2010 |
Last Update Date | 05/02/2010 |