Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 03796 | NH |
NPI | 1588979009 |
---|---|
Provider Name | Dr. Shane T. Citron |
First Address | Manchester, NH 03103-3502 |
Second Address | Manchester, NH 03103-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2010 |
Last Update Date | 09/08/2010 |