Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DEN1000212 | DC |
NPI | 1215052378 |
---|---|
Provider Name | Wanda L Davidson |
First Address | Washington, DC 20006-1103 |
Second Address | Washington, DC 20006-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |