Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 17250 | NJ |
NPI | 1104033398 |
---|---|
Provider Name | Davia D. Strachan |
First Address | South Orange, NJ 07079-2642 |
Second Address | South Orange, NJ 07079-2642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 11/01/2013 |