Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 82 | CO |
NPI | 1063570760 |
---|---|
Provider Name | Richard L Mcmanaman |
First Address | Longmont, CO 80501-2462 |
Second Address | Longmont, CO 80501-2462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |