Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 26079 | CA |
NPI | 1003981622 |
---|---|
Provider Name | Dr. Ezra H Kantor |
First Address | San Rafael, CA 94903-3432 |
Second Address | San Rafael, CA 94903-3432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |