Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 7979 | GA |
NPI | 1023413481 |
---|---|
Provider Name | Dr. Tobin Trotter |
First Address | Augusta, GA 30907-3525 |
Second Address | Augusta, GA 30907-3525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2014 |
Last Update Date | 28/10/2014 |