Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 165652 |
NPI | 1134582943 |
---|---|
Provider Name | Nina Daniels |
First Address | Salt Lake City, UT 84148-0001 |
Second Address | Salt Lake City, UT 84148-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 30/03/2016 |