Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 11797 | MI |
NPI | 1093877391 |
---|---|
Provider Name | Dr. David William Dolan |
First Address | Flint, MI 48507-2908 |
Second Address | Flint, MI 48507-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |