Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902015255 | MI |
NPI | 1023399607 |
---|---|
Provider Name | Ms. Sabrina Latrice Basley |
First Address | Dearborn Heights, MI 48127-1066 |
Second Address | Detroit, MI 48214-3730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2011 |
Last Update Date | 08/09/2011 |