Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS023315L | PA |
NPI | 1003892688 |
---|---|
Provider Name | Dr. Wayne B Lapetoda |
First Address | San Diego, CA 92124-2459 |
Second Address | San Diego, CA 92124-2459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 28/08/2008 |