Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 10770 | CO |
NPI | 1003162223 |
---|---|
Provider Name | Miss Nicholas Mills Sigman |
First Address | Boulder, CO 80305-7601 |
Second Address | Superior, CO 80027-8625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2012 |
Last Update Date | 25/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12-195-0213 | COLORADO DRIVER LICENSE (01) | CO |