Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 13132 | MI |
NPI | 1154420644 |
---|---|
Provider Name | Dr. Benjamin John Czerniawski |
First Address | Grosse Pointe Woods, MI 48236 |
Second Address | Grosse Pointe Woods, MI 48236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |