Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 0402203521 | VA |
NPI | 1023786969 |
---|---|
Provider Name | Sherry L Basham |
First Address | Dumfries, VA 22025-1107 |
Second Address | Woodbridge, VA 22192-4263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2021 |
Last Update Date | 04/09/2021 |