Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 1001201-15 | WI |
NPI | 1053730002 |
---|---|
Provider Name | Dr. David Picadizo Hamm |
First Address | Madison, WI 53716-1349 |
Second Address | Madison, WI 53716-1349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 21/10/2021 |