Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 0442000402 | VA |
NPI | 1205450319 |
---|---|
Provider Name | Kipley Powell |
First Address | Richmond, VA 23298-0257 |
Second Address | Richmond, VA 23298-0566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2020 |
Last Update Date | 17/08/2020 |