Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 00202008 | CO |
Y | 1223D0001X | Dental Public Health | 30720 | TX |
NPI | 1215362637 |
---|---|
Provider Name | Codi Etel Astiasaran |
First Address | Abilene, TX 79602-1272 |
Second Address | Cross Plains, TX 76443-2581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2013 |
Last Update Date | 27/04/2015 |