Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 14569 | MA |
NPI | 1013139450 |
---|---|
Provider Name | George D Sydlar JR. |
First Address | Ayer, MA 01432 |
Second Address | Ayer, MA 01432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |