Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 16030 | MD |
NPI | 1003369448 |
---|---|
Provider Name | Ekaterina Spirina |
First Address | Cambridge, MD 21613-1916 |
Second Address | Cambridge, MD 21613-1916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2016 |
Last Update Date | 02/08/2016 |