Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DD4690 | NM |
N | 1223G0001X | General Practice | DD4690 | NM |
N | 213EG0000X | General Practice | DD4690 | NM |
NPI | 1003355363 |
---|---|
Provider Name | David Chodosh |
First Address | Albuquerque, NM 87102-2070 |
Second Address | Rio Rancho, NM 87124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2017 |
Last Update Date | 17/07/2018 |