Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 98000619A | IN |
NPI | 1164848685 |
---|---|
Provider Name | Dr. Gerardo Maupome-Carvantes |
First Address | Indianapolis, IN 46202-2855 |
Second Address | Indianapolis, IN 46202-2855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2014 |
Last Update Date | 07/03/2014 |