Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS017365L | PA |
NPI | 1043497183 |
---|---|
Provider Name | Marlind Harry Stiles |
First Address | Erie, PA 16508-2830 |
Second Address | Erie, PA 16508-2830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 30/01/2008 |