Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 20626 | TX |
NPI | 1992897870 |
---|---|
Provider Name | Mrs. Aziebong M Atang |
First Address | Pasadena, TX 77502 |
Second Address | Pasadena, TX 77502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 12/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
143989503 | (05) | TX |