Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 027509 | NY |
NPI | 1033864616 |
---|---|
Provider Name | Renata Dworak |
First Address | Bloomingburg, NY 12721-4710 |
Second Address | Bloomingburg, NY 12721-4710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2022 |
Last Update Date | 13/02/2022 |