Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 08475 | IA |
NPI | 1063640027 |
---|---|
Provider Name | Dr. Suzanne Elizabeth Stock |
First Address | Iowa City, IA 52240-6626 |
Second Address | Iowa City, IA 52240-6626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2009 |
Last Update Date | 29/06/2009 |