Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DDS-09048 | IA |
NPI | 1134552995 |
---|---|
Provider Name | Dr. Daniel David Hiserote JR. |
First Address | Sioux Center, IA 51250-1120 |
Second Address | Sioux Center, IA 51250-1120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2013 |
Last Update Date | 01/12/2015 |