Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 18939 | TX |
NPI | 1033210158 |
---|---|
Provider Name | Elizabeth Joseph |
First Address | Irving, TX 75062-4493 |
Second Address | Irving, TX 75062-4493 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 16/04/2014 |