Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 058720 | NY |
Y | 1223E0200X | Endodontist | 058720 | NY |
NPI | 1154701209 |
---|---|
Provider Name | Dr. Bilal Damlaj |
First Address | Syracuse, NY 13208-2672 |
Second Address | Cicero, NY 13039-9585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 27/08/2020 |