Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DEN5014 | DC |
NPI | 1134266562 |
---|---|
Provider Name | Sally Jo Cram |
First Address | Washington, DC 20036-6601 |
Second Address | Washington, DC 20036-6601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |