Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 25046 | WV |
NPI | 1033211081 |
---|---|
Provider Name | Mr. Larry Keith Hildebrand |
First Address | Huntington, WV 25704 |
Second Address | Huntington, WV 25704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |