Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 25028 | TX |
NPI | 1225362882 |
---|---|
Provider Name | Dr. Ernesto Carmona JR. |
First Address | Austin, TX 78729-1711 |
Second Address | Austin, TX 78729-1711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2009 |
Last Update Date | 22/12/2015 |