Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2843 | LA |
NPI | 1023144904 |
---|---|
Provider Name | George P Marse JR. |
First Address | Metairie, LA 70006-6549 |
Second Address | Metairie, LA 70006-6549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |