Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 006525 | CT |
NPI | 1033512488 |
---|---|
Provider Name | Ms. Stephanie Lyn Thompson I |
First Address | Torrington, CT 06790-6427 |
Second Address | Torrington, CT 06790-6427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2014 |
Last Update Date | 30/09/2014 |