Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4590 | LA |
NPI | 1003958216 |
---|---|
Provider Name | Dr. Alise Steward |
First Address | New Orleans, LA 70185-0013 |
Second Address | New Orleans, LA 70119-6017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 09/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1845906 | (05) | LA |