Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | LL17804 | OR |
N | 207W00000X | Ophthalmologist | M-11960 | ID |
NPI | 1003064577 |
---|---|
Provider Name | David Gerald Dance |
First Address | Hayden, ID 83835 |
Second Address | Coeur D Alene, ID 83814-2540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2008 |
Last Update Date | 29/04/2013 |