Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D-5009-PD | ID |
NPI | 1093247462 |
---|---|
Provider Name | Devin Wright Belnap |
First Address | Pocatello, ID 83202-5122 |
Second Address | Pocatello, ID 83201-3622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 18/09/2019 |