Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2901021463 | MI |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2021-02207 | NC |
NPI | 1164829438 |
---|---|
Provider Name | Dr. David Scott Coviak |
First Address | Charlotte, NC 28210-8917 |
Second Address | Charlotte, NC 28210-8917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2014 |
Last Update Date | 21/07/2021 |