Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401004157 | VA |
NPI | 1043382245 |
---|---|
Provider Name | Dr. James Paul Soderquist |
First Address | Charlottesville, VA 22902-5353 |
Second Address | Charlottesville, VA 22902-5353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 09/07/2007 |