Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 028190-1 | NY |
NPI | 1003008012 |
---|---|
Provider Name | Dr. John R. Whiteman |
First Address | Niagara Falls, NY 14301-1507 |
Second Address | Niagara Falls, NY 14301-1507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 14/08/2007 |