Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN1856460 | MA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A127360 | CA |
NPI | 1073871448 |
---|---|
Provider Name | Sampeter Liech Odera |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 19/05/2015 |