Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 47084 | CA |
NPI | 1053359042 |
---|---|
Provider Name | Mr. Daniel Haberman |
First Address | Sacramento, CA 95831-3437 |
Second Address | Sacramento, CA 95831-3437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 08/07/2007 |