Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7888 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 7888 | KY |
NPI | 1396923595 |
---|---|
Provider Name | Matthew David D'addario |
First Address | Lexington, KY 40509-4127 |
Second Address | Colorado Springs, CO 80920-1022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 11/04/2008 |