Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1645 | MD |
NPI | 1063533487 |
---|---|
Provider Name | Trudy J Dean |
First Address | Denton, MD 21629-1243 |
Second Address | Denton, MD 21629-1243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 13/08/2007 |