Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS0000008304 | TN |
NPI | 1003846569 |
---|---|
Provider Name | Dr. David Richard Cagna |
First Address | Memphis, TN 38163-0001 |
Second Address | Memphis, TN 38163-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 22/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U53275 | (02) | TN |