Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS030001L | PA |
NPI | 1033232855 |
---|---|
Provider Name | Maria Concepcion |
First Address | Paoli, PA 19301-1743 |
Second Address | Paoli, PA 19301-1743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2007 |
Last Update Date | 08/07/2007 |