Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 105955 | CO |
NPI | 1063639805 |
---|---|
Provider Name | Dr. David L Nock |
First Address | Grand Junction, CO 81506-1910 |
Second Address | Grand Junction, CO 81506-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02059558 | (05) | CO |
105955 | STATE LICENSE NUMBER (01) | CO |