Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4397 | CO |
NPI | 1063578086 |
---|---|
Provider Name | Dr. Paul A. Hamersky |
First Address | Lone Tree, CO 80124-5504 |
Second Address | Lone Tree, CO 80124-5504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 06/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4397 | DENTIST LICENSE NO. (01) | CO |