Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 7845 | KY |
NPI | 1073711917 |
---|---|
Provider Name | Thomas C Garner |
First Address | Louisville, KY 40223-1251 |
Second Address | Louisville, KY 40223-1281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100019440 | (05) | KY |