Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 5101017258 | MI |
Y | 207YS0123X | Facial Plastic Surgeon | P6804 | TX |
NPI | 1881887867 |
---|---|
Provider Name | Dr. Kimi Dart |
First Address | Brownwood, TX 76801-5906 |
Second Address | Brownwood, TX 76801-5906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 19/03/2015 |