NPI | 1720334469 |
---|---|
Former Name | TIFFANY LEE PAYNE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AK 163709) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415690) |
124Q00000X Dental Hygienist (Licence: TX 11759) | |
124Q00000X Dental Hygienist (Licence: NM DH3737) | |
Enumeration Date | 2012-07-31 |
Last Update Date | 2020-08-31 |