Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1376994772 |
---|---|
Provider Name | Ms. Omega Rhone |
First Address | Fort Bragg, NC 28310-7324 |
Second Address | Fort Bragg, NC 28310-7324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 27/06/2016 |