Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12521 | MA |
NPI | 1235164930 |
---|---|
Provider Name | Roger W. Sachs |
First Address | Danvers, MA 01923-4207 |
Second Address | Danvers, MA 01923-2135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T57097 | (02) | MA |