Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8493 | KY |
NPI | 1033372057 |
---|---|
Provider Name | Lawrence Sivori II |
First Address | Louisville, KY 40220-2742 |
Second Address | Louisville, KY 40220-2742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 06/11/2013 |