Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 1901 | NM |
NPI | 1144475518 |
---|---|
Provider Name | David A. Irvin |
First Address | Albuquerque, NM 87109-1455 |
Second Address | Albuquerque, NM 87109-1455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2008 |
Last Update Date | 26/11/2008 |