Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | IL | |
N | 1223P0300X | Periodontist | IL |
NPI | 1023138120 |
---|---|
Provider Name | Dr. Kirk William Noraian |
First Address | Bloomington, IL 61704-3528 |
Second Address | Bloomington, IL 61704-3528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 08/07/2007 |