Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 11703 | MO |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 1556 | AZ |
N | 1223X0400X | Orthodontists | 950 | NM |
NPI | 1013941459 |
---|---|
Provider Name | Dr. Paul Anderson Lines |
First Address | Tempe, AZ 85282-2440 |
Second Address | Tempe, AZ 85282-2440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |