Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 12007350A | IN |
N | 1223D0001X | Dental Public Health | 12007350A | IN |
NPI | 1538299300 |
---|---|
Provider Name | Dr. Bernida Lucile Iqbal |
First Address | Gallup, NM 87301-4511 |
Second Address | Richmond, IN 47374-2851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |