Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 71.000230 | OH |
NPI | 1043650310 |
---|---|
Provider Name | Dr. Andre Paes Batista Da Silva |
First Address | Cleveland, OH 44106-1712 |
Second Address | Cleveland, OH 44106-1712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 01/07/2013 |