Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 30537 | CA |
NPI | 1265425383 |
---|---|
Provider Name | Dr. John Patrick Depner |
First Address | Escondido, CA 92029-5812 |
Second Address | San Diego, CA 92145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 08/07/2007 |