Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH000201302 | CO |
NPI | 1053880377 |
---|---|
Provider Name | Roberta Dee Benz |
First Address | Monument, CO 80132-9074 |
Second Address | Monument, CO 80132-9074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2018 |
Last Update Date | 15/11/2018 |