Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 30470 | CA |
NPI | 1043506009 |
---|---|
Provider Name | Dr. Gary R. Sanner |
First Address | Bellflower, CA 90706 |
Second Address | Bellflower, CA 90706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 30/01/2018 |