Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 7176-15 | WI |
Y | 1223E0200X | Endodontist | 10704 | TN |
N | 1223E0200X | Endodontist | 9954 | NC |
N | 1223E0200X | Endodontist | DE 60730973 | WA |
NPI | 1063834505 |
---|---|
Provider Name | Dr. Michael Dyriw |
First Address | Nashville, TN 37221-1847 |
Second Address | Nashville, TN 37221-1847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2014 |
Last Update Date | 18/11/2019 |