Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7576 | NE |
NPI | 1275194771 |
---|---|
Provider Name | Dr. Chandler L. Walpole |
First Address | Grand Island, NE 68803-1334 |
Second Address | Grand Island, NE 68803-1334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2019 |
Last Update Date | 25/06/2019 |