Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 03580 | NH |
NPI | 1134335979 |
---|---|
Provider Name | Dr. Eric Lee Gotlieb |
First Address | Portsmouth, NH 03801-5821 |
Second Address | Exeter, NH 03833-4871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 02/04/2013 |