Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DEN DEN LIC 6020 | MT |
NPI | 1003230111 |
---|---|
Provider Name | Dr. Taylor Diggs |
First Address | Missoula, MT 59803-1485 |
Second Address | Missoula, MT 59803-1485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2014 |
Last Update Date | 16/02/2016 |