Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | MD 6942 | MD |
NPI | 1003817677 |
---|---|
Provider Name | Terry E Dornburg |
First Address | Grantsville, MD 21536-0359 |
Second Address | Grantsville, MD 21536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2005 |
Last Update Date | 08/07/2007 |