Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 16321 | AZ |
NPI | 1235134503 |
---|---|
Provider Name | Dr. Daniel James Klemmedson |
First Address | Tucson, AZ 85712-1227 |
Second Address | Tucson, AZ 85712-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 24/04/2010 |