Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 12885 | AR |
NPI | 1144717364 |
---|---|
Provider Name | Taylor Brooke Martin |
First Address | North Little Rock, AR 72118-1593 |
Second Address | North Little Rock, AR 72118-1593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2018 |
Last Update Date | 13/04/2018 |