Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1295495117 |
---|---|
Provider Name | Ms. Sabrina Tinker |
First Address | Springfield, MO 65806-1131 |
Second Address | Springfield, MO 65806-1131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2021 |
Last Update Date | 20/12/2021 |