Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 2860 | SC |
Y | 1223P0700X | Prosthodontist | 8659 | TN |
NPI | 1013085240 |
---|---|
Provider Name | Dr. Robert P Dziejma |
First Address | Brentwood, TN 37027 |
Second Address | Brentwood, TN 37027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 31/07/2008 |