Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 30014316 | OH |
NPI | 1003974965 |
---|---|
Provider Name | Dr. Frank Louis Pace JR. |
First Address | Bowling Green, OH 43402-2667 |
Second Address | Bowling Green, OH 43402-2667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0270997 | (05) | OH |