Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8776 | MD |
N | 204E00000X | Oral & Maxillofacial Surgeon | D0041703 | MD |
NPI | 1558667980 |
---|---|
Provider Name | Dr. Steven Robert Kishter |
First Address | Rockville, MD 20852-2865 |
Second Address | Rockville, MD 20852-2865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2011 |
Last Update Date | 04/08/2011 |