Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 20116 | TX |
NPI | 1083694988 |
---|---|
Provider Name | Dr. Chadwick Miles Sargent |
First Address | Lubbock, TX 79424-5308 |
Second Address | Lubbock, TX 79424-5308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 03/02/2014 |