Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5563-015 | WI |
NPI | 1023027786 |
---|---|
Provider Name | Dr. Ian Dozier |
First Address | Eau Claire, WI 54701-6133 |
Second Address | Altoona, WI 54720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 23/12/2021 |