Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 16006 | MD |
Y | 1223E0200X | Endodontist | DN1858721 | MA |
NPI | 1144776923 |
---|---|
Provider Name | Dr. Dominic Do |
First Address | Laurel, MD 20723-2061 |
Second Address | North Chicago, IL 60064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 05/12/2021 |