Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5900 | MD |
NPI | 1154433365 |
---|---|
Provider Name | Dr. Louis George Depaola |
First Address | Glenwood, MD 21738-9503 |
Second Address | Balto, MD 21230-3856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |