Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | XT014746 | IN |
NPI | 1295878494 |
---|---|
Provider Name | Ms. Tonya Dawn Marks |
First Address | Indianapolis, IN 46268-4486 |
Second Address | Indianapolis, IN 46268-4486 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |