Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN22298 | FL |
N | 204E00000X | Oral & Maxillofacial Surgeon | A141168 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DL-10923 | MA |
NPI | 1073834248 |
---|---|
Provider Name | James R Tagoni |
First Address | Marion, IA 52302-8975 |
Second Address | Cedar Rapids, IA 52403-2407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 27/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DDS-09834 | STATE LICENSE (01) | IA |