Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 12007547A |
NPI | 1366553570 |
---|---|
Provider Name | Dr. Gary L Breslauer |
First Address | Indianapolis, IN 46220-2233 |
Second Address | Indianapolis, ID 46220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |