Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 030365-1 | NY |
N | 1223E0200X | Endodontist | D6065 | AZ |
NPI | 1164500542 |
---|---|
Provider Name | Lawrence Frank Pace |
First Address | Williamsville, NY 14221-2159 |
Second Address | Williamsville, NY 14221-2159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 09/02/2012 |