Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 016-0002060 | VT |
NPI | 1023192648 |
---|---|
Provider Name | Dr. Dara Chira, Dmd |
First Address | Burlington, VT 05408 |
Second Address | Burlington, VT 05401-2709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VT 016-0002060 | ORTHODONTICS (01) | VT |