Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 22HI00788500 | NJ |
NPI | 1073002051 |
---|---|
Provider Name | Natalie Gast |
First Address | Califon, NJ 07830-4375 |
Second Address | Califon, NJ 07830-4375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2018 |
Last Update Date | 06/05/2018 |