Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 8116 | KY |
Y | 1223P0221X | Pediatric Dentist | 8116 | KY |
NPI | 1013095421 |
---|---|
Provider Name | Dr. Morgan Chase Dillow |
First Address | Lexington, KY 40509-2275 |
Second Address | Lexington, KY 40509-2275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 28/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60004041 | (05) | KY |