Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 12700 | TX |
NPI | 1023639010 |
---|---|
Provider Name | Ronni Renee Gallina |
First Address | Palestine, TX 75801-5254 |
Second Address | Crockett, TX 75835-3417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2020 |
Last Update Date | 30/04/2020 |