Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1205247723 |
---|---|
Provider Name | Natasha Edwards |
First Address | Havana, FL 32333-1442 |
Second Address | Havana, FL 32333-1442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 19/05/2014 |