Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901021982 | MI |
Y | 1223E0200X | Endodontist | DEN1002020 | DC |
NPI | 1033561329 |
---|---|
Provider Name | Stephanie Serrano |
First Address | Washington, DC 20036-3717 |
Second Address | Washington, DC 20036-3717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2016 |
Last Update Date | 03/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017192835 | (05) | DC |