Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D-3906 | ID |
Y | 1223E0200X | Endodontist | D-3906 | ID |
NPI | 1114901261 |
---|---|
Provider Name | Scott Vassel Schlofman |
First Address | Ft Bliss, TX 79920 |
Second Address | Ft Bliss, TX 79920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 27/08/2015 |