Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5126 | AL |
NPI | 1003811241 |
---|---|
Provider Name | Dr. Tara Lambert Moncus |
First Address | Rainsville, AL 35986-1069 |
Second Address | Rainsville, AL 35986-5215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 30/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009932625 | (05) | AL |