Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 3329 | SC |
NPI | 1588769186 |
---|---|
Provider Name | Dr. Anthony Likes |
First Address | Pawhuska, OK 74056-3201 |
Second Address | Pawhuska, OK 74056-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |