Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4848 | AZ |
NPI | 1023164233 |
---|---|
Provider Name | Stephanie Joan Malcher |
First Address | Chandler, AZ 85224-2216 |
Second Address | Chandler, AZ 85224-2216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2007 |
Last Update Date | 08/07/2007 |