Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 6056 | NE |
NPI | 1063533479 |
---|---|
Provider Name | Dr. Lawrence Calvin Parrish |
First Address | Omaha, NE 68178-0001 |
Second Address | Omaha, NE 68178-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 01/07/2008 |