Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 12009826 | IN |
N | 213EG0000X | General Practice | 12009826 | IN |
N | 1223P0700X | Prosthodontist | 12009826 | IN |
NPI | 1053403022 |
---|---|
Provider Name | Dr. Louis D Menegotto |
First Address | Avon, IN 46123-7982 |
Second Address | Avon, IN 46123-7982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |