Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 6202 | LA |
NPI | 1114359346 |
---|---|
Provider Name | Dr. Regine Dyer |
First Address | Metairie, LA 70005-5907 |
Second Address | Metairie, LA 70005-5907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2013 |
Last Update Date | 27/06/2016 |