Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2901600175 | MI |
NPI | 1003466038 |
---|---|
Provider Name | Dr. Andrei Dan Taut |
First Address | Livonia, MI 48152-3077 |
Second Address | Livonia, MI 48152-3077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2019 |
Last Update Date | 11/09/2019 |