Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 53401 | CA |
NPI | 1063568343 |
---|---|
Provider Name | Gerald Snell |
First Address | Laguna Hills, CA 92653-7533 |
Second Address | Laguna Hills, CA 92653-7533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |