Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 176881 | ZZ |
NPI | 1023260635 |
---|---|
Provider Name | Daniel Oscar Constandse |
First Address | El Paso, TX 79996-2707 |
Second Address | Juarez, CHIHUAHUA 32310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2008 |
Last Update Date | 14/10/2008 |