Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | AL3997 | AL |
NPI | 1003925611 |
---|---|
Provider Name | David Alva Dauphin |
First Address | Dothan, AL 36303 |
Second Address | Dothan, AL 36303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |