Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 11900 | MN |
NPI | 1144298910 |
---|---|
Provider Name | Christopher R Bevin |
First Address | North Adams, MA 01247-2538 |
Second Address | North Adams, MA 01247-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 13/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0218910 | (05) | MA |
1014291 | (05) | VT |
V00628 | (02) |