Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS028828L | PA |
NPI | 1124289491 |
---|---|
Provider Name | Dr. Gregory Charles Pedro |
First Address | Wyomissing, PA 19610-1799 |
Second Address | Wyomissing, PA 19610-1799 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 19/06/2008 |