Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7910 | NC |
NPI | 1568531358 |
---|---|
Provider Name | Robert Dolven |
First Address | Hayesville, NC 28904-7946 |
Second Address | Hayesville, NC 28904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 15/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5908685 | (05) | NC |