Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 42174 | CA |
NPI | 1033565205 |
---|---|
Provider Name | Sheri Widdis |
First Address | Moorpark, CA 93021-4125 |
Second Address | Moorpark, CA 93021-4125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2016 |
Last Update Date | 06/05/2016 |