Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1174658041 |
---|---|
Provider Name | Mr. Michael T Embry |
First Address | South San Francisco, CA 94080-3948 |
Second Address | South San Francisco, CA 94080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |