Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 6408 | CO |
NPI | 1386722585 |
---|---|
Provider Name | Dr. William Lynn Canada |
First Address | Bemidji, MN 56601-3638 |
Second Address | Bemidji, MN 56601-3638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |