Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DDS-09961 | IA |
NPI | 1083368229 |
---|---|
Provider Name | Dr. Danielle Ann Nici |
First Address | Oklahoma City, OK 73103-6402 |
Second Address | Iowa City, IA 52240-3111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2022 |
Last Update Date | 07/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DDS-09961 | IOWA DENTAL BOARD (01) | IA |