Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 30-01-8599 | OH |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30018599 | OH |
NPI | 1528047479 |
---|---|
Provider Name | Dr. Michael P Powers |
First Address | Kent, OH 44240 |
Second Address | Kent, OH 44240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 01/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0677754 | (05) | OH |
135349222-00 | BUREAU OF WORKER'S COMP (01) | OH |
T48758 | (02) | |
T48758 | (02) | OH |