Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 26594 | CA |
NPI | 1043586928 |
---|---|
Provider Name | Mitchell S Bronson |
First Address | Bakersfield, CA 93311-1359 |
Second Address | Bakersfield, CA 93311-1359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 26/03/2012 |