Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 155 | AK |
NPI | 1023267796 |
---|---|
Provider Name | Dr. Keith C Coombs |
First Address | Anchorage, AK 99508-5051 |
Second Address | Anchorage, AK 99508-5051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2008 |
Last Update Date | 17/09/2008 |