Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1376992719 |
---|---|
Provider Name | Ms. Xenia Key |
First Address | Columbus, GA 31906-1002 |
Second Address | Fort Benning, GA 31905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 07/06/2016 |