Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1189 | MT |
NPI | 1053648014 |
---|---|
Provider Name | Theresa Anne O'neil |
First Address | Thompson Falls, MT 59873-9476 |
Second Address | Thompson Falls, MT 59873-9476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2009 |
Last Update Date | 12/11/2009 |