Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1295034353 |
---|---|
Provider Name | Stacey Lynn Pomales |
First Address | Vineland, NJ 08360-6915 |
Second Address | Vineland, NJ 08360-6915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2011 |
Last Update Date | 15/03/2011 |