Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DDS101295 | CA |
NPI | 1063770691 |
---|---|
Provider Name | Dr. Darryl Anthony Caesar |
First Address | Stockton, CA 95212 |
Second Address | Stockton, CA 95205-4272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 29/06/2017 |