Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1306298997 |
---|---|
Provider Name | Roslyn Faulk |
First Address | Frot Polk, LA 71459 |
Second Address | Frot Polk, LA 71459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2016 |
Last Update Date | 07/07/2016 |