Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 43456 | CA |
N | 1223X0400X | Orthodontists | 43456 | CA |
NPI | 1003038142 |
---|---|
Provider Name | Dr. Clarice Law Eyre |
First Address | Los Angeles, CA 90019-1533 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |