Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2006007559 | MO |
N | 1223D0001X | Dental Public Health | 2006007559 | MO |
NPI | 1437150810 |
---|---|
Provider Name | Shoeleh Navab-Hamidi |
First Address | Kirksville, MO 63501-2548 |
Second Address | Kirksville, MO 63501-3407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 06/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
405451401 | (05) | MO |