Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | IL |
NPI | 1013025444 |
---|---|
Provider Name | Dr. Elaine Waite Piedra |
First Address | Naperville, IL 60540-4714 |
Second Address | Naperville, IL 60540-6503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 08/07/2007 |