Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 2943 | ND |
NPI | 1255680187 |
---|---|
Provider Name | Dr. Dionisio Teng Libi |
First Address | Fargo, ND 58104 |
Second Address | Fargo, ND 58104-7118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 06/09/2012 |