Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | M832 | SD |
NPI | 1083703193 |
---|---|
Provider Name | Dr. Melvin Neil Thaler |
First Address | Sioux Falls, SD 57105-4266 |
Second Address | Sioux Falls, SD 57105-4266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M832 | (05) | SD |