Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0308281 | NY |
NPI | 1003946286 |
---|---|
Provider Name | Dr. James Thomas Duval |
First Address | Buffalo, NY 14209-1604 |
Second Address | Buffalo, NY 14209-1604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00623161 | (05) | NY |