Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 45766 | CA |
NPI | 1053465591 |
---|---|
Provider Name | Erik H Roos |
First Address | Chico, CA 95973 |
Second Address | Chico, CA 95973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 31/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45766 | DENTIST LICENSE (01) | CA |