Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 3170 | SC |
NPI | 1871606830 |
---|---|
Provider Name | Jonathan M Lafond |
First Address | Charleston, SC 29420-7424 |
Second Address | Summerville, SC 29485-5669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
970893 | UNITED CONCORDIA (01) | SC |
U64827 | (02) | SC |
Z31706 | (05) | SC |