Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 34715 | NY |
NPI | 1003964404 |
---|---|
Provider Name | Dr. William R. Caryl, Jr. |
First Address | Camillus, NY 13031-2327 |
Second Address | Camillus, NY 13031-2327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |