Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 12341 | NJ |
NPI | 1104978931 |
---|---|
Provider Name | Dr. Carol E Mann |
First Address | South Orange, NJ 07079-2202 |
Second Address | South Orange, NJ 07079-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |