Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 0006264 | CT |
NPI | 1003233149 |
---|---|
Provider Name | Terri Davis |
First Address | Wellesley, MA 02482-3744 |
Second Address | Middletown, CT 06457-3396 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 24/10/2014 |