Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 19712 | TX |
Y | 1223P0700X | Prosthodontist | 9525 | CO |
NPI | 1194841858 |
---|---|
Provider Name | Dr. Thomas Albert Ding |
First Address | Basalt, CO 81621-1597 |
Second Address | Basalt, CO 81621-9251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 23/07/2008 |