Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 11123 | NC |
NPI | 1861988362 |
---|---|
Provider Name | Xiaoying Deng |
First Address | Fayetteville, NC 28311-2130 |
Second Address | Fayetteville, NC 28311-2130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2018 |
Last Update Date | 08/07/2018 |