Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 23 | MT |
NPI | 1952523961 |
---|---|
Provider Name | Mr. Dylan James Sedlacek |
First Address | Billings, MT 59102 |
Second Address | Billings, MT 59102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0158185 | (05) | MT |