Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 107292 | TX |
NPI | 1275090961 |
---|---|
Provider Name | Shelby Morgan Tullos |
First Address | Timpson, TX 75975 |
Second Address | Timpson, TX 75975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2019 |
Last Update Date | 28/02/2019 |