Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 12648 | MA |
Y | 1223X0400X | Orthodontists | 1339 | NH |
NPI | 1053427112 |
---|---|
Provider Name | Dr. John Robert Bednar |
First Address | Nashua, NH 03064 |
Second Address | Nashua, NH 03064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89191903 | (05) | NH |