Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0401412914 | VA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 12010200A | IN |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DE00011016 | WA |
NPI | 1114903739 |
---|---|
Provider Name | Dr. Nathaniel D Tricker |
First Address | Charlottesville, VA 22901 |
Second Address | Charlottesville, VA 22901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 23/08/2010 |