Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 029474 | NY |
NPI | 1104921485 |
---|---|
Provider Name | Dr. Mark Ward Bain |
First Address | Depew, NY 14043-2309 |
Second Address | Depew, NY 14043-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |