Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4106 | NE |
NPI | 1053353011 |
---|---|
Provider Name | Dr. David Manary |
First Address | Grand Island, NE 68803-2153 |
Second Address | Grand Island, NE 68803-2153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 12/07/2007 |