Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 12010166A | IN |
NPI | 1033260773 |
---|---|
Provider Name | Burton V Largura |
First Address | Carmel, IN 46033-4602 |
Second Address | Kokomo, IN 46902-8007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |