Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 00204010 | CO |
NPI | 1295393114 |
---|---|
Provider Name | Reanna Leigh Messer |
First Address | Steamboat Springs, CO 80487-8853 |
Second Address | Oak Creek, CO 80467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2019 |
Last Update Date | 05/06/2019 |