Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DD2346 | NM |
NPI | 1558415125 |
---|---|
Provider Name | Dr. David Jones |
First Address | Corrales, NM 87048-8307 |
Second Address | Corrales, NM 87048-8307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 07/08/2007 |