Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | MT29 | MT |
NPI | 1770866113 |
---|---|
Provider Name | Sandin Craig Barney |
First Address | Conrad, MT 59425 |
Second Address | Conrad, MT 59425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2011 |
Last Update Date | 22/09/2011 |