Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 144118 | NC |
NPI | 1114067816 |
---|---|
Provider Name | Suzette Rohrer |
First Address | Pfafftown, NC 27040-9721 |
Second Address | Winston Salem, NC 27101-4366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |