Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA82815 |
NPI | 1134882541 |
---|---|
Provider Name | Ms. Stefanie Aileen Taggett |
First Address | Fresno, CA 93720-2698 |
Second Address | Fresno, CA 93720-2698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2021 |
Last Update Date | 21/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA82815 | (05) | CA |