Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 4224 | MD |
NPI | 1750425294 |
---|---|
Provider Name | Dr. Richard Carlos Tatum SR. |
First Address | Columbia, MD 21044-3264 |
Second Address | Columbia, MD 21044-3264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2007 |
Last Update Date | 08/07/2007 |