Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 5474 | CO |
N | 1223D0001X | Dental Public Health | D9110 | MN |
NPI | 1013086032 |
---|---|
Provider Name | Dr. Wayne Michael Deutsch |
First Address | San Diego, CA 92136-5596 |
Second Address | San Diego, CA 92136-5596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |