Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901010497 | MI |
NPI | 1043285562 |
---|---|
Provider Name | Dr. Arunas S Vaitiekaitis |
First Address | Port Huron, MI 48060-3745 |
Second Address | Port Huron, MI 48060-3745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2995989 | (05) | MI |
4060802 | (05) | MI |
U21883 | (02) | MI |