Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 07712 | IA |
NPI | 1033134358 |
---|---|
Provider Name | Todd M Juhlin |
First Address | Iowa City, IA 52245 |
Second Address | Iowa City, IA 52245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 19/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0184226 | (05) | IA |
U75041 | (02) | IA |