Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4875 | KS |
NPI | 1073673976 |
---|---|
Provider Name | Dr. Clifford Winters Vanblarcom |
First Address | Prairie Village, KS 66208-1426 |
Second Address | Prairie Village, KS 66208-1426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |