Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 13543 | MD |
NPI | 1073594586 |
---|---|
Provider Name | James Robert Snodgrass |
First Address | Lavale, MD 21502-7129 |
Second Address | Lavale, MD 21502-7129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006729 | MPC (01) | MD |
0137670000 | (05) | WV |
1694475 | UCCI (01) | MD |