Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DK036615 | CA |
NPI | 1013047497 |
---|---|
Provider Name | Paul James Steigerwald |
First Address | Santa Rosa, CA 95404-4610 |
Second Address | Santa Rosa, CA 95404-4610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DK036615 | DENTAL LICENSE NUMBER (01) | CA |