Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 4601 | SC |
NPI | 1235713447 |
---|---|
Provider Name | Regina Shaye Dase |
First Address | Piedmont, SC 29673-7708 |
Second Address | Piedmont, SC 29673-7708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2021 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4601 | DENTAL HYGIENIST (01) | SC |