Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 10292 | NC |
N | 1223G0001X | General Practice | 10292 | NC |
N | 213EG0000X | General Practice | 10292 | NC |
NPI | 1659636736 |
---|---|
Provider Name | Dr. Douglas Sconia Sanford JR. |
First Address | Chapel Hill, NC 27514-1650 |
Second Address | Chapel Hill, NC 27514-1650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1659636736 | (05) | NC |