Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 18821 | FL |
NPI | 1033387113 |
---|---|
Provider Name | Ms. Nesie Domingo Dacula |
First Address | Parker, AZ 85344-7718 |
Second Address | Parker, AZ 85344-7718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 12/02/2008 |