Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0156 | SC |
NPI | 1003836776 |
---|---|
Provider Name | Dr. Frederick Madison Gunter |
First Address | North Charleston, SC 29420-4209 |
Second Address | North Charleston, SC 29420-4209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |