Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901010538 | MI |
NPI | 1467509737 |
---|---|
Provider Name | Dr. David Michael Repasky |
First Address | Ypsilanti, MI 48197-2127 |
Second Address | Wayne, MI 48184-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1846106 | (05) | MI |