Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Dental |
261QD0000X |
| NPI Number | 1245417625 |
| LBN Legal business name | BRANCH DENTAL CLINIC YUMA |
| Authorized official | WILLIAM CONDON - (NAVY MEDICINE UBO PROGRAM MANAGER) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 01/28/2008 |
| Last updated | 05/25/2018 - About 8 years ago |
| Identifiers | n/a |
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