Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | NC 4858 | NC |
NPI | 1144240854 |
---|---|
Provider Name | Dr. Gary R Kushner |
First Address | Charlotte, NC 28208-4228 |
Second Address | Charlotte, NC 28208-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015N0 | NC HEALTH CHOICE (01) | NC |
89902YU | (05) | NC |