Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 054058 | NY |
NPI | 1063665016 |
---|---|
Provider Name | Dr. Cosmina Olariu Nolan |
First Address | Fayetteville, NY 13066-9692 |
Second Address | Fayetteville, NY 13066-9692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 03/11/2008 |