Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 49711 | CA |
NPI | 1326285727 |
---|---|
Provider Name | Antonio Gamez |
First Address | Long Beach, CA 90805-6613 |
Second Address | Orange, CA 92867-7716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 07/01/2009 |