Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0021 | NC |
N | 1223P0300X | Periodontist | 17520 | MA |
NPI | 1043374135 |
---|---|
Provider Name | Dr. David Wayne Paquette |
First Address | Chapel Hill, NC 27514-7613 |
Second Address | Chapel Hill, NC 27599-7450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89-96589 | (05) | NC |
U52771 | (02) |