Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 12009732 | IN |
NPI | 1003914110 |
---|---|
Provider Name | Dr. Iris Corina Mcnicholl |
First Address | Indianapolis, IN 46202 |
Second Address | Indianapolis, IN 46202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200169270A | (05) | IN |