Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 14871 | TX |
NPI | 1023291143 |
---|---|
Provider Name | Tangela F Wheeler-Moxley |
First Address | Rochester, NY 14616-3521 |
Second Address | Coppell, TX 75019-5028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 12/12/2007 |