Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 64165465 | GA |
NPI | 1326405572 |
---|---|
Provider Name | Sarah Hankla |
First Address | Dallas, TX 75247-4914 |
Second Address | Dallas, TX 75247-4914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2016 |
Last Update Date | 19/01/2016 |