Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4894 | VA |
NPI | 1215189816 |
---|---|
Provider Name | Brian A Mahler |
First Address | Fairfax, VA 22030-3133 |
Second Address | Fairfax, VA 22030-3133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2008 |
Last Update Date | 15/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125750358 | AMERICAN DENTAL ASSOCIATION ID NUMBER (01) | VA |