Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 40485 | CA |
NPI | 1023044260 |
---|---|
Provider Name | Mr. Jeffrey Politz |
First Address | Napa, CA 94558-3087 |
Second Address | Napa, CA 94558-3087 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 11/02/2014 |