Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH.000904428 | CO |
NPI | 1043679087 |
---|---|
Provider Name | Pamela Nichol Bray |
First Address | Telluride, CO 81435-3644 |
Second Address | Telluride, CO 81435-3644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2016 |
Last Update Date | 18/02/2016 |