Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901022035 | MI |
NPI | 1003279100 |
---|---|
Provider Name | Davis Zubke |
First Address | Escanaba, MI 49829-3411 |
Second Address | Escanaba, MI 49829-3411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2016 |
Last Update Date | 12/09/2016 |