Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS-038193 | PA |
NPI | 1013115070 |
---|---|
Provider Name | Dr. Ankur Johri |
First Address | Allentown, PA 18103-6205 |
Second Address | Allentown, PA 18103-6205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 27/04/2015 |