Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 33787500 | WI |
NPI | 1043421449 |
---|---|
Provider Name | Dr. Edward M Bancker |
First Address | Stevens Point, WI 54481 |
Second Address | Stevens Point, WI 54481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38392500 | (05) | WI |