Individual
KEONE TYAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 N INDIANA AVE, WINSLOW, AZ 86004
(928) 289-6116
Mailing address
500 N INDIANA AVE, WINSLOW, AZ 86004
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
50058186
NY
Other
Enumeration date
09/16/2015
Last updated
09/16/2015
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