Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 12012265A | IN |
N | 122300000X | Dentist | 28267 | TX |
N | 122300000X | Dentist | 2901020780 | MI |
N | 1223D0004X | Dentist Anesthesiologist | 137000907 | IL |
Y | 1223P0300X | Periodontist | 021002624 | IL |
N | 1223P0300X | Periodontist | 28267 | TX |
N | 1223P0300X | Periodontist | 4134 | WV |
NPI | 1558678813 |
---|---|
Provider Name | Dr. Saiprasad M Zemse |
First Address | Tinker Afb, OK 73145-8716 |
Second Address | Tinker Afb, OK 73145-8716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 07/05/2018 |