Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2013030815 | MO |
NPI | 1205099645 |
---|---|
Provider Name | Dr. Dahlia T Michael |
First Address | Springfield, MO 65801-5681 |
Second Address | Springfield, MO 65806-1131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 28/01/2016 |