Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D6377 | AZ |
NPI | 1033139670 |
---|---|
Provider Name | Dr. David P Ember |
First Address | Chandler, AZ 85226-2065 |
Second Address | Chandler, AZ 85224-5678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
930710 | (05) | AZ |