Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 020.013888 | IL |
N | 124Q00000X | Dental Hygienist | 13007000A | IN |
NPI | 1063032464 |
---|---|
Provider Name | Silsan Kaminski |
First Address | Valparaiso, IN 46385-7215 |
Second Address | Chicago Heights, IL 60411-1799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2020 |
Last Update Date | 24/05/2020 |