Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 0401414321 | VA |
Y | 1223G0001X | General Practice | 0401414321 | VA |
Y | 213EG0000X | General Practice | 0401414321 | VA |
NPI | 1720403280 |
---|---|
Provider Name | Dr. Janice De Vito |
First Address | Baltimore, MD 21224-5173 |
Second Address | Baltimore, MD 21224-5173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2014 |
Last Update Date | 20/02/2014 |