Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 034261-1 | NY |
NPI | 1073653028 |
---|---|
Provider Name | Dr. John Deangelo |
First Address | Rochester, NY 14623-1603 |
Second Address | Rochester, NY 14623-1603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |