Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 009099 | MO |
NPI | 1003946674 |
---|---|
Provider Name | Dr. William Harper Marchbanks |
First Address | Higginsville, MO 64037-1171 |
Second Address | Higginsville, MO 64037-1171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009099 | LICENSE (01) | MO |
29914 | BNDD (01) | MO |
BM2624591 | DEA (01) |