Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1225210131 |
---|---|
Provider Name | Vanessa Martinez |
First Address | Crowley, TX 76036 |
Second Address | Arlington, TX 76012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2007 |
Last Update Date | 03/12/2007 |