Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7741 | MD |
NPI | 1013030212 |
---|---|
Provider Name | Patricio Herdoiza |
First Address | Gaithersburg, MD 20878-5446 |
Second Address | Gaithersburg, MD 20878-5446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |