Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 1692 | SC |
NPI | 1104935717 |
---|---|
Provider Name | Dr. David West Ivey |
First Address | Summerville, SC 29483 |
Second Address | Summerville, SC 29483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |