Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 3843 | AZ |
NPI | 1093775488 |
---|---|
Provider Name | Dr. Richard C. Jirsa |
First Address | Prescott, AZ 86301-1427 |
Second Address | Prescott, AZ 86301-1427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 25/02/2009 |