Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1225259153 |
---|---|
Provider Name | Ms. Shirley Mann |
First Address | Lititz, PA 17543-8850 |
Second Address | Lititz, PA 17543-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |