Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN015163 | GA |
Y | 1223E0200X | Endodontist | DN015613 | GA |
NPI | 1003268285 |
---|---|
Provider Name | Dr. Christian Dahl |
First Address | Gainesville, GA 30501-3426 |
Second Address | Gainesville, GA 30501-3426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2016 |
Last Update Date | 20/11/2021 |