Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5659 | LA |
NPI | 1073704706 |
---|---|
Provider Name | Dr. David Victor Scaffidi |
First Address | Kenner, LA 70065-2853 |
Second Address | Kenner, LA 70065-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 12/09/2007 |