Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0365091 | NY |
NPI | 1043347438 |
---|---|
Provider Name | John D. Callahan JR. |
First Address | Fayetteville, NY 13066-2041 |
Second Address | Fayetteville, NY 13066-2041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |