Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 39717 | CA |
NPI | 1073681110 |
---|---|
Provider Name | Dr. Noellette P Tangtrongsakdi-Falkow |
First Address | Mill Valley, CA 94941-2246 |
Second Address | Mill Valley, CA 94941-2246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/06/2009 |