Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | DA4821 | NM |
NPI | 1346700283 |
---|---|
Provider Name | Ms. Tiffany Ann Brown |
First Address | Cameron, NC 28326-5542 |
Second Address | Cameron, NC 28326-5542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2019 |
Last Update Date | 25/03/2019 |