Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7166 | NE |
NPI | 1003220823 |
---|---|
Provider Name | Dr. James Trexel |
First Address | Geneva, NE 68361-2007 |
Second Address | Geneva, NE 68361-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 19/06/2014 |