Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DE00011112 | WA |
Y | 1223P0221X | Pediatric Dentist | D-4108-PD | ID |
NPI | 1003993445 |
---|---|
Provider Name | Dr. Karen Marie Sept |
First Address | Moscow, ID 83843-2277 |
Second Address | Moscow, ID 83843-2277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807993200 | (05) | ID |