Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 007612 | CT |
NPI | 1013309392 |
---|---|
Provider Name | Sarah Bortolan |
First Address | Norwalk, CT 06851-5710 |
Second Address | Norwalk, CT 06851-5710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2015 |
Last Update Date | 24/02/2015 |