Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1366114803 |
---|---|
Provider Name | Payton Renard Diggins |
First Address | Carlisle Barracks, PA 17013-5091 |
Second Address | Carlisle Barracks, PA 17013-5090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2021 |
Last Update Date | 04/10/2021 |