Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 22HI00983400 | NJ |
NPI | 1033466222 |
---|---|
Provider Name | Sarita Bontu |
First Address | Perth Amboy, NJ 08862-1220 |
Second Address | Perth Amboy, NJ 08861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2012 |
Last Update Date | 07/08/2012 |