Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D4868 | AZ |
N | 204E00000X | Oral & Maxillofacial Surgeon | 23387 | AZ |
NPI | 1275681330 |
---|---|
Provider Name | Dr. Carl J. Gassmann |
First Address | Scottsdale, AZ 85260-5518 |
Second Address | Scottsdale, AZ 85260-5518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |