Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DH18473 | FL |
NPI | 1245395078 |
---|---|
Provider Name | Peggy Burns |
First Address | Houston, TX 77039-5530 |
Second Address | Houston, TX 77039-5530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 03/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
076119200 | (05) | FL |