Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH012993 | GA |
NPI | 1073020723 |
---|---|
Provider Name | Neil William Edens |
First Address | Kingsford, MI 49802-5219 |
Second Address | Iron Mountain, MI 49801-4760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2018 |
Last Update Date | 03/01/2018 |