Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DV030694 | CA |
NPI | 1003903857 |
---|---|
Provider Name | Ronald Power |
First Address | Martinez, CA 94553-4098 |
Second Address | Martinez, CA 94553-3156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |