Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 032409 | CA |
NPI | 1033376728 |
---|---|
Provider Name | Edward Tritico |
First Address | Hollister, CA 95023-5700 |
Second Address | Hollister, CA 95023-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 20/05/2008 |