Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 2368 | LA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2368 | LA |
NPI | 1386709285 |
---|---|
Provider Name | Dr. Edward Charles Massett JR. |
First Address | Slidell, LA 70461 |
Second Address | Slidell, LA 70461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 11/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00450504 | (05) | MS |
1823686 | (05) | LA |
T19826 | (02) |