Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 12102 | TX |
N | 1223X0400X | Orthodontists | 12102 | TX |
NPI | 1033102611 |
---|---|
Provider Name | Dr. John H. Case |
First Address | Bryan, TX 77802-5215 |
Second Address | Bryan, TX 77802-5215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T03164 | (02) | TX |