Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 60978 | CA |
NPI | 1003123902 |
---|---|
Provider Name | Nicole Jean Flanigan |
First Address | Half Moon Bay, CA 94019-2187 |
Second Address | Half Moon Bay, CA 94019-2187 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2010 |
Last Update Date | 14/05/2012 |