Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1205285525 |
---|---|
Provider Name | Mr. Edward Roland Cedillo |
First Address | Fort Hood, TX 76544-5042 |
Second Address | Fort Hood, TX 76544-5042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 07/06/2016 |