Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 35773 | TX |
NPI | 1205385523 |
---|---|
Provider Name | Jose Escobar |
First Address | Katy, TX 77449-5299 |
Second Address | Waller, TX 77484-8022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2016 |
Last Update Date | 28/09/2016 |