Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN11008 | FL |
NPI | 1043665250 |
---|---|
Provider Name | Gregory Dyer |
First Address | Tampa, FL 33618-4608 |
Second Address | Tampa, FL 33618-4608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 26/04/2016 |