Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 22D102154800 | NJ |
NPI | 1407876212 |
---|---|
Provider Name | Dr. Krystin Ann Bandola |
First Address | Hillsborough, NJ 08844-4693 |
Second Address | Hillsborough, NJ 08844-4693 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 09/01/2015 |