Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 59994 | CA |
NPI | 1053742130 |
---|---|
Provider Name | John Snowden |
First Address | Montebello, CA 90640-3667 |
Second Address | Montebello, CA 90640-3667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2013 |
Last Update Date | 27/11/2013 |