Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 10828 | TX |
NPI | 1104094226 |
---|---|
Provider Name | Edward A Neusel |
First Address | Austin, TX 78746-3203 |
Second Address | Silsbee, TX 77656-4141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 11/02/2008 |