Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 31477 | CA |
NPI | 1073593489 |
---|---|
Provider Name | Dr. Robert H. Iezman |
First Address | Berkeley, CA 94709-1512 |
Second Address | Berkeley, CA 94709-1512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 08/07/2007 |