Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 10090 | TX |
NPI | 1043365232 |
---|---|
Provider Name | Dr. David Steven Wilbanks |
First Address | El Paso, TX 79912-3904 |
Second Address | El Paso, TX 79912-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |