Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DEN5254 | DC |
NPI | 1124177605 |
---|---|
Provider Name | Dr. Olga Fonseca |
First Address | Washington, DC 20036-1722 |
Second Address | Washington, DC 20036-1722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |