Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 110831 | AK |
Y | 1223E0200X | Endodontist | RES.004408 | OH |
NPI | 1063870855 |
---|---|
Provider Name | Brandon Astin |
First Address | Beachwood, OH 44122-1377 |
Second Address | Cleveland, OH 44106-1666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2016 |
Last Update Date | 19/07/2021 |