Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 0401004907 | VA |
NPI | 1184892358 |
---|---|
Provider Name | George Lawrence Nance JR. |
First Address | Newport News, VA 23608 |
Second Address | Newport News, VA 23608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 11/02/2008 |