Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 90325 | CA |
NPI | 1346843158 |
---|---|
Provider Name | Silvio Simunovic |
First Address | San Francisco, CA 94122-3448 |
Second Address | San Francisco, CA 94122-3448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2020 |
Last Update Date | 16/11/2020 |