Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 44324 | CA |
NPI | 1104877380 |
---|---|
Provider Name | Adam Joseph Janette |
First Address | San Luis Obispo, CA 93405-5803 |
Second Address | San Luis Obispo, CA 93405-5803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 08/07/2007 |