Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 005 | MT |
NPI | 1427183946 |
---|---|
Provider Name | Mr. James Robert Carnahan |
First Address | Hamilton, MT 59840 |
Second Address | Hamilton, MT 59840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 14/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0154955 | (05) | MT |