Individual
STASHA OUTLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
84465
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126800000
DENTAL ASSISTANT
CA
Enumeration date
10/05/2015
Last updated
10/05/2015
Update your record
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