Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DD3454 | NM |
NPI | 1023130085 |
---|---|
Provider Name | Dr. James Franklin Wolcott IV |
First Address | Santa Fe, NM 87505-4782 |
Second Address | Santa Fe, NM 87505-4782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 10/01/2012 |