Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 201905 | CO |
NPI | 1033103544 |
---|---|
Provider Name | Ms. Tammy Lark Honold |
First Address | Ignacio, CO 81137-9100 |
Second Address | Ignacio, CO 81137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 08/07/2007 |