Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 08281 | IA |
NPI | 1083699474 |
---|---|
Provider Name | Jyoti Prakash Chowdhury |
First Address | Waterloo, IA 50702-5839 |
Second Address | Waterloo, IA 50702-5839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 21/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0076372 | (05) | IA |