Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 11114 | MD |
NPI | 1124116413 |
---|---|
Provider Name | Dr. Edward Alan Zupnik |
First Address | Bethesda, MD 20814-3107 |
Second Address | Bethesda, MD 20814-3107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |