Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 12010966A | IN |
N | 204E00000X | Oral & Maxillofacial Surgeon | 01065709A | IN |
NPI | 1306837182 |
---|---|
Provider Name | Mr. Harry Papadopoulos |
First Address | Richmond, IN 47374-1936 |
Second Address | Richmond, IN 47374-1936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 19/08/2011 |