Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 04563 | IA |
NPI | 1073614087 |
---|---|
Provider Name | Dr. James Reichert Hugg |
First Address | Burlington, IA 52601-5043 |
Second Address | Burlington, IA 52601-5043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |