Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 8695 | CO |
NPI | 1093849788 |
---|---|
Provider Name | Dr. Anthony Gustav Gegauff |
First Address | Ridgway, CO 81432-9203 |
Second Address | Ridgway, Co, CO 81432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |