Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12449 | OH |
NPI | 1104821933 |
---|---|
Provider Name | Dr. Emilio D Ferrara |
First Address | Kent, OH 44240-4112 |
Second Address | Kent, OH 44240-4112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000126771 | ANTHEM (01) | OH |
0080577 | (05) | OH |
605929 | COMPDENT (01) | OH |
T45858 | (02) | OH |