Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 0401415851 | VA |
Y | 1223E0200X | Endodontist | S7-111C | NV |
NPI | 1093226177 |
---|---|
Provider Name | Dr. Sameer Dilip Jain |
First Address | Richmond, VA 23298 |
Second Address | Las Vegas, NV 89147-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2017 |
Last Update Date | 22/04/2021 |