Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 59156 | CA |
Y | 1223P0221X | Pediatric Dentist | 59156 | CA |
NPI | 1043532351 |
---|---|
Provider Name | Dr. Petr Kadera |
First Address | Sacramento, CA 95834 |
Second Address | Yuba City, CA 95991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2010 |
Last Update Date | 24/03/2020 |