Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 50945 | CA |
NPI | 1275850190 |
---|---|
Provider Name | Teanne Marie Duval |
First Address | Palmdale, CA 93591-3412 |
Second Address | Lancaster, CA 93534-3333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2010 |
Last Update Date | 02/05/2010 |