Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DD3880 | NM |
NPI | 1417223694 |
---|---|
Provider Name | Dr. Liang-Tso Tung |
First Address | Los Lunas, NM 87031-8841 |
Second Address | Los Lunas, NM 87031-8841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2012 |
Last Update Date | 22/11/2013 |