Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 7046 | FL |
NPI | 1053325852 |
---|---|
Provider Name | Dr. Paul Werner |
First Address | Boca Raton, FL 33433-4813 |
Second Address | Boca Raton, FL 33433-4813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 16/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070831301 | (05) | FL |