Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN10711 | FL |
NPI | 1174553689 |
---|---|
Provider Name | Dr. John Anthony Bidwell |
First Address | Tallahassee, FL 32316 |
Second Address | Tallahassee, FL 32304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |