Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2326 | MT |
NPI | 1578712246 |
---|---|
Provider Name | Daniel Wordal |
First Address | Helena, MT 59601-4759 |
Second Address | Helena, MT 59601-4759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2008 |
Last Update Date | 14/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1578712246 | (05) | MT |