Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 4245 | NC |
NPI | 1003978750 |
---|---|
Provider Name | Dr. Rolando Andre Prado |
First Address | Wilson, NC 27893-4464 |
Second Address | Wilson, NC 27893-4464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8997060 | (05) | NC |
97060 | BCBS NCHC DENTAL SERVICE (01) | NC |