Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1326337353 |
---|---|
Provider Name | Joseph Maciag |
First Address | Apo, AA 00901-0100 |
Second Address | San Juan, PR 00901-1818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 30/03/2011 |