Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DD1241 | NM |
NPI | 1053314674 |
---|---|
Provider Name | Dr. Paul J Krispinsky |
First Address | Ranchos De Taos, NM 87557-9709 |
Second Address | Taos, NM 87571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1241 | NM BOARD OF DENTAL HEALTH (01) | NM |