Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS036776 | PA |
NPI | 1043383821 |
---|---|
Provider Name | Dr. Bryan Evan Stein |
First Address | Lancaster, PA 17601-6322 |
Second Address | Lancaster, PA 17601-6322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 05/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114040105 | ADA (01) | |
118280 | AAE (01) | |
BS9876410 | DEA LICENSE (01) | PA |
DS036776 | DENTAL LICENSE (01) | PA |