Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 48905 | CA |
NPI | 1003014093 |
---|---|
Provider Name | Dr. Charles Leo Drury |
First Address | Bonsall, CA 92003-3624 |
Second Address | Bonsall, CA 92003-3624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1753898 | UNITED CONCORDIA (01) | |
48905 | DELTA (01) |