Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 24500 | TX |
N | 1223E0200X | Endodontist | DS030073-L | PA |
NPI | 1063432565 |
---|---|
Provider Name | Dr. Susan Kaye Pedott |
First Address | San Antonio, TX 78221-1535 |
Second Address | Houston, TX 77069-4519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 30/07/2010 |