Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 046024 | NY |
NPI | 1003955378 |
---|---|
Provider Name | Dr. Maxim V. Skormin |
First Address | Hamburg, NY 14075-4921 |
Second Address | Hamburg, NY 14075-4921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |