Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4352 | MD |
NPI | 1043321235 |
---|---|
Provider Name | Dr. William John Mislowsky |
First Address | Lutherville, MD 21093-6204 |
Second Address | Lutherville, MD 21093-6204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V087 | (02) |