Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 10044 | TN |
NPI | 1043552722 |
---|---|
Provider Name | Brian Wah |
First Address | Franklin, TN 37067-8227 |
Second Address | Franklin, TN 37067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 14/08/2019 |