Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1889 | SC |
NPI | 1003023128 |
---|---|
Provider Name | Theresa Dowdy |
First Address | Bennettsville, SC 29512 |
Second Address | Lexington, SC 29072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |