Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0401007684 | VA |
NPI | 1134285356 |
---|---|
Provider Name | Dr. David Ludwig Krese |
First Address | Charlottesville, VA 22902-5353 |
Second Address | Charlottesville, VA 22902-5353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |