Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 23676 | TX |
N | 1223E0200X | Endodontist | 54730 | CA |
NPI | 1003027699 |
---|---|
Provider Name | Dr. Staci R Ianiro |
First Address | Austin, TX 78745-1565 |
Second Address | Austin, TX 78745-1565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 09/09/2008 |