Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6963 | KY |
N | 1223D0001X | Dental Public Health | 6963 | KY |
NPI | 1679538482 |
---|---|
Provider Name | J. Daniel West |
First Address | Murray, KY 42071 |
Second Address | Murray, KY 42071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 08/03/2011 |