Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 83515 | CA |
NPI | 1326443334 |
---|---|
Provider Name | Shari D Tyler |
First Address | Long Beach, CA 90813 |
Second Address | Los Angeles, CA 90025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2014 |
Last Update Date | 03/11/2014 |