Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | TX18904 | TX |
NPI | 1053516369 |
---|---|
Provider Name | Dr. Ralf Fritz Poineal |
First Address | Paris, TX 75460-4492 |
Second Address | Paris, TX 75460-4492 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 08/07/2007 |