Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 25876 | CA |
NPI | 1073500625 |
---|---|
Provider Name | Dr. Laurence A Darrow |
First Address | Los Gatos, CA 95032-2003 |
Second Address | Los Gatos, CA 95032-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
506124 | DENTICAL (01) |