Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 31658 | NY |
NPI | 1003074840 |
---|---|
Provider Name | Dr. Richard Bates Chaffee JR. |
First Address | Auburn, NY 13021-4812 |
Second Address | Auburn, NY 13021-4812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 29/05/2008 |