Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DD2274 | NM |
N | 1223D0001X | Dental Public Health | DD2274 | NM |
NPI | 1679561716 |
---|---|
Provider Name | Donna Kidby |
First Address | Santa Fe, NM 87505-7314 |
Second Address | Santa Fe, NM 87505-4031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89029313 | (05) | NY |