Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 6620034-9921 | UT |
Y | 1223P0221X | Pediatric Dentist | 60953 | KS |
NPI | 1104019793 |
---|---|
Provider Name | Dr. Robinson Todd Kiser |
First Address | Leavenworth, KS 66048-2822 |
Second Address | Leavenworth, KS 66048-2822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 31/03/2017 |