Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H9394 | MN |
NPI | 1023583408 |
---|---|
Provider Name | Sara Graff |
First Address | Onamia, MN 56359-2241 |
Second Address | Onamia, MN 56359-2241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2018 |
Last Update Date | 11/10/2018 |