Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 401410767 | VA |
Y | 1223E0200X | Endodontist | 0401410767 | VA |
NPI | 1134171010 |
---|---|
Provider Name | Dr. Mark Vagnetti |
First Address | Charlottesville, VA 22911-3569 |
Second Address | Charlottesville, VA 22911-3569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 23/09/2014 |