Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 31-003462 | OH |
NPI | 1073998944 |
---|---|
Provider Name | Rise A. Gibson |
First Address | Barnesville, OH 43713 |
Second Address | Marietta, OH 45750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2015 |
Last Update Date | 21/07/2015 |