Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 8817 | KY |
NPI | 1083943906 |
---|---|
Provider Name | James Doll |
First Address | Louisville, KY 40222-4822 |
Second Address | Great Lakes, IL 60088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2009 |
Last Update Date | 24/12/2009 |