Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS039262 | PA |
NPI | 1003280124 |
---|---|
Provider Name | Dr. Hayward Benton Drane IV |
First Address | Media, PA 19063-1763 |
Second Address | Media, PA 19063-1763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2015 |
Last Update Date | 02/12/2015 |