Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 016-0001168 | VT |
NPI | 1053357194 |
---|---|
Provider Name | Dr. John Fenning Steinman |
First Address | Barre, VT 05641-3312 |
Second Address | Barre, VT 05641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1005331 | (05) | VT |