Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 025017 | NY |
NPI | 1043468721 |
---|---|
Provider Name | Shannon R. Benedek |
First Address | Lewiston, NY 14092-1013 |
Second Address | Lewiston, NY 14092-1013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2008 |
Last Update Date | 05/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025017 | NYS LICENSE (01) | NY |