Individual
MYONG HOUSEHOLDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
305 VANGUARD RD, FORT STEWART, GA 31314
(912) 435-6229
Mailing address
773 BRIGHAM DR, RICHMOND HILL, GA 31324
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
07/08/2016
Last updated
07/08/2016
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