Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 11509 | NC |
N | 204E00000X | Oral & Maxillofacial Surgeon | DL-11243 | MA |
NPI | 1285920769 |
---|---|
Provider Name | Samuel N Addison |
First Address | Raleigh, NC 27615-3546 |
Second Address | Raleigh, NC 27615-3546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 26/06/2019 |