Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | 057835 | NY |
N | 1223D0004X | Dentist Anesthesiologist | 11212 | NC |
Y | 1223D0004X | Dentist Anesthesiologist | 29881 | TX |
NPI | 1871759621 |
---|---|
Provider Name | Dr. Iris Lo |
First Address | Round Rock, TX 78681-1149 |
Second Address | Round Rock, TX 78681-1149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 28/07/2020 |