Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901022205 | MI |
NPI | 1003346453 |
---|---|
Provider Name | Dr. Robert Wayne Iveson III |
First Address | Coldwater, MI 49036-2062 |
Second Address | Coldwater, MI 49036-2062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2017 |
Last Update Date | 05/12/2018 |