Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 50011 | ME |
NPI | 1346415940 |
---|---|
Provider Name | Roger Paul Martin |
First Address | Hartland, ME 04943 |
Second Address | Hartland, ME 04943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50011 | STATE LIC (01) | ME |