Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 045777 | NY |
N | 1223X0400X | Orthodontists | 045777 | NY |
NPI | 1033298559 |
---|---|
Provider Name | Dr. Mark A. Paciorek |
First Address | Camillus, NY 13031-2313 |
Second Address | Camillus, NY 13031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 13/11/2017 |