Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H7601 | MN |
N | 126800000X | Dental Assistant | A9581 | MN |
NPI | 1245894740 |
---|---|
Provider Name | Oksana Yarmolich |
First Address | Saint Paul, MN 55107-2236 |
Second Address | Saint Paul, MN 55107-2236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2019 |
Last Update Date | 30/04/2019 |