Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 056120-1 | NY |
NPI | 1104145804 |
---|---|
Provider Name | Erin Shope |
First Address | Rochester, NY 14620-2913 |
Second Address | Rochester, NY 14620-2913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2010 |
Last Update Date | 18/10/2012 |