Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2901009646 | MI |
NPI | 1225203714 |
---|---|
Provider Name | Dr. William H Roedema |
First Address | Grandville, MI 49418-2003 |
Second Address | Grandville, MI 49418-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2008 |
Last Update Date | 25/04/2008 |