Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 015576 | MO |
NPI | 1063743300 |
---|---|
Provider Name | Dr. John Ralph Firth |
First Address | Sunset Hills, MO 63127 |
Second Address | Sunset Hills, MO 63127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2010 |
Last Update Date | 27/01/2010 |