Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | LD-128 | ID |
NPI | 1609449305 |
---|---|
Provider Name | Michael Chase Mings |
First Address | Twin Falls, ID 83301-4708 |
Second Address | Twin Falls, ID 83301-4708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2021 |
Last Update Date | 20/07/2021 |