Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 056141-1 | NY |
NPI | 1003106477 |
---|---|
Provider Name | Mr. Ross Morgan |
First Address | Woodbury, NY 11797-1014 |
Second Address | Woodbury, NY 11797-1014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2011 |
Last Update Date | 26/09/2012 |