Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0452481 | NY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 1974071 | NY |
NPI | 1194865907 |
---|---|
Provider Name | Dr. David William Todd |
First Address | Lakewood, NY 14750 |
Second Address | Lakewood, NY 14750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01477343 | (05) | NY |
U49433 | (02) |