Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 10850096-9922 | UT |
NPI | 1003307802 |
---|---|
Provider Name | Dr. Dick Nathan Einerson |
First Address | Blanding, UT 84511-4115 |
Second Address | Montezuma Creek, UT 84511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2018 |
Last Update Date | 29/05/2018 |