Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 18066 | MA |
NPI | 1003966912 |
---|---|
Provider Name | Benjamin Gamm |
First Address | Norfolk, MA 02056-1301 |
Second Address | Norfolk, MA 02056-1301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |