Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 7743 | NC |
NPI | 1063414175 |
---|---|
Provider Name | Dr. Luis Antonio Chamorro |
First Address | Charlotte, NC 28226-5314 |
Second Address | Charlotte, NC 28226-5314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 08/07/2007 |