Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH.002024544 | CO |
NPI | 1063967081 |
---|---|
Provider Name | Tasha L. Gibson |
First Address | Olathe, CO 81425-0529 |
Second Address | Olathe, CO 81425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2016 |
Last Update Date | 25/04/2019 |