Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 008100 | CT |
NPI | 1003947425 |
---|---|
Provider Name | Dr. Mark S Roisman |
First Address | Westport, CT 06880-3216 |
Second Address | Westport, CT 06880-3216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |