Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 30016314 | OH |
NPI | 1083782387 |
---|---|
Provider Name | Dr. James Irwin Matia |
First Address | Wooster, OH 44691-2378 |
Second Address | Wooster, OH 44691-2378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |