Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | LD-05 | ID |
NPI | 1457490526 |
---|---|
Provider Name | Mr. Frank Compton Harris |
First Address | Blackfoot, ID 83221-2226 |
Second Address | Blackfoot, ID 83221-2226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |