Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0401416524 | VA |
NPI | 1720549769 |
---|---|
Provider Name | Nader Douglas Burpee |
First Address | Roanoke, VA 24017-2716 |
Second Address | Roanoke, VA 24017-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2019 |
Last Update Date | 02/07/2020 |