Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1285124230 |
---|---|
Provider Name | Ms. Stephanie Powers |
First Address | Fort Meade, MD 20755-7083 |
Second Address | Fort Carson, CO 80913-4095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2018 |
Last Update Date | 25/09/2019 |