Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30.24774 | OH |
Y | 122300000X | Dentist | 9747 | KY |
NPI | 1003264888 |
---|---|
Provider Name | Ms. Virginia Brooke Faulkner |
First Address | Newport, KY 41071-2203 |
Second Address | Covington, KY 41011-3313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2016 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100410240 | (05) | KY |