Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 131651 | UT |
NPI | 1003950833 |
---|---|
Provider Name | Dr. Joseph Doyle Liddle |
First Address | American Fork, UT 84003 |
Second Address | American Fork, UT 84003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 08/07/2007 |