Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 58597 | CA |
NPI | 1023373362 |
---|---|
Provider Name | Dr. Beau Ulrich |
First Address | Auburn, CA 95603-5121 |
Second Address | Auburn, CA 95603-5121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 12/07/2012 |