Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9918 | CO |
NPI | 1003193426 |
---|---|
Provider Name | Dr. Paul J. Lombardi |
First Address | Colorado Springs, CO 80917-5147 |
Second Address | Colorado Springs, CO 80910-3127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2011 |
Last Update Date | 04/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16129229 | (05) | CO |