Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17559 | MA |
NPI | 1104847292 |
---|---|
Provider Name | Dr. Herman Strating |
First Address | Beverly, MA 01915-1116 |
Second Address | Beverly, MA 01915-1116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 08/07/2007 |