Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 25121 | CA |
NPI | 1033243423 |
---|---|
Provider Name | Thomas E Bianchi |
First Address | Stockton, CA 95219-2355 |
Second Address | Stockton, CA 95219-2355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |