Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22D101499300 | NJ |
NPI | 1073677639 |
---|---|
Provider Name | Dr. Sara M Fonseca |
First Address | Moorestown, NJ 08057-1561 |
Second Address | Moorestown, NJ 08057-1561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |