Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 21063 | OH |
NPI | 1093737322 |
---|---|
Provider Name | Dr. Russell Kiser II |
First Address | Mansfield, OH 44907-2229 |
Second Address | Mansfield, OH 44907-2229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 31/03/2016 |