Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 30334 | CA |
NPI | 1225496771 |
---|---|
Provider Name | Dr. Tony Daher |
First Address | La Verne, CA 91750-3451 |
Second Address | La Verne, CA 91750-3451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2016 |
Last Update Date | 28/01/2016 |