Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2154 | SC |
NPI | 1013053552 |
---|---|
Provider Name | Dr. Harry George Bobotis |
First Address | Greenville, SC 29601-4427 |
Second Address | Greenville, SC 29601-4427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |