Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1003362559 |
---|---|
Provider Name | Mr. Angel Rodrigueztapia |
First Address | Fort Knox, KY 40121-5116 |
Second Address | Fort Knox, KY 40121-5210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2016 |
Last Update Date | 25/08/2016 |