Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 00202978 | CO |
Y | 1223P0221X | Pediatric Dentist | 2313 | ND |
NPI | 1003358755 |
---|---|
Provider Name | Taylor Zmoos |
First Address | Minot, ND 58701-1200 |
Second Address | Minot, ND 58701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2016 |
Last Update Date | 27/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1451163 | (05) | ND |