Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 21 | SC |
NPI | 1093105579 |
---|---|
Provider Name | Timothy Rohde |
First Address | Charleston, SC 29425-8908 |
Second Address | Charleston, SC 29425-8908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2015 |
Last Update Date | 04/02/2015 |