Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 330 | AK |
Y | 1223X0400X | Orthodontists | 9 | AK |
NPI | 1003170291 |
---|---|
Provider Name | Walter John Babula |
First Address | Fairbanks, AK 99701-5937 |
Second Address | Fairbanks, AK 99701-5937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2012 |
Last Update Date | 02/07/2012 |