Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | DR61068962 | WA |
NPI | 1184251423 |
---|---|
Provider Name | Daniel Bandary |
First Address | Bronx, NY 10467-2401 |
Second Address | Bronx, NY 10467-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2020 |
Last Update Date | 25/10/2021 |