Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 12011425A | IN |
NPI | 1003127564 |
---|---|
Provider Name | Dr. John Michael Pasicznyk |
First Address | Indianapolis, IN 46240-1569 |
Second Address | Indianapolis, IN 46240-1569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 18/09/2015 |