Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1356791024 |
---|---|
Provider Name | Rashamel Smart |
First Address | Fort Huachuca, AZ 85613-5080 |
Second Address | Fort Huachuca, AZ 85613-5080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2016 |
Last Update Date | 14/06/2016 |