Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 15101 | MD |
Y | 1223E0200X | Endodontist | DN20965 | FL |
NPI | 1023397163 |
---|---|
Provider Name | Dr. Christopher Andrew Widmer |
First Address | Naples, FL 34119-8658 |
Second Address | Naples, FL 34103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2011 |
Last Update Date | 20/11/2018 |