Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5325 | CT |
NPI | 1043435050 |
---|---|
Provider Name | Dr. Mark Jeffrey Schpero |
First Address | New Haven, CT 06511-1325 |
Second Address | Hamden, CT 06518-3691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |