Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901012332 | MI |
NPI | 1043360738 |
---|---|
Provider Name | Dr. Joseph Alan Furchi |
First Address | Livonia, MI 48152-1227 |
Second Address | Taylor, MI 48180-4835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2901012332 | DENTAL LICENSE (01) | MI |
4054000 | (05) | MI |