Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6965 | KS |
NPI | 1003979584 |
---|---|
Provider Name | Dr. William Vermont Stenberg |
First Address | Tahlequah, OK 74464-2512 |
Second Address | Tahlequah, OK 74464-2512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9330951 | (05) | OK |