Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | L545017 | MI |
N | 1223X0400X | Orthodontists | L545016 | MI |
NPI | 1073665824 |
---|---|
Provider Name | Larry Majznerski |
First Address | Wyoming, MI 49509-4483 |
Second Address | Wyoming, MI 49509-4483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |