Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2020017366 | MO |
NPI | 1003432311 |
---|---|
Provider Name | David Dumbach |
First Address | Rolla, MO 65401-2448 |
Second Address | Rolla, MO 65401-2448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2020 |
Last Update Date | 23/06/2020 |