Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 019031655 | IL |
NPI | 1174017834 |
---|---|
Provider Name | Dr. Daniel Pagel |
First Address | Crest Hill, IL 60403-1881 |
Second Address | Crest Hill, IL 60403-1881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2018 |
Last Update Date | 18/06/2018 |