Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 048011-1 | NY |
NPI | 1013034784 |
---|---|
Provider Name | Dr. Andrew Joseph Dvonch |
First Address | Victor, NY 14564-1341 |
Second Address | Rochester, NY 14618-4517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |