Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 019027093 | IL |
NPI | 1699916924 |
---|---|
Provider Name | Dr. Matthew Raymond Rozny |
First Address | Galesburg, IL 61401-2436 |
Second Address | Galesburg, IL 61401-2436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2009 |
Last Update Date | 17/03/2009 |