Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 7507 | NC |
NPI | 1134270937 |
---|---|
Provider Name | Mr. John Francis Wisniewski |
First Address | Cary, NC 27513-8485 |
Second Address | Cary, NC 27513-8485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |