Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901019744 | MI |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2901019744 | MI |
NPI | 1184861080 |
---|---|
Provider Name | Theodora E Danciu |
First Address | Toledo, OH 43614-1509 |
Second Address | Ann Arbor, MI 48109-1078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2009 |
Last Update Date | 29/01/2020 |