Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 30430 | NY |
NPI | 1073502258 |
---|---|
Provider Name | Dr. Gary W Bigsby |
First Address | Endicott, NY 13760-5036 |
Second Address | Endicott, NY 13760-5036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 08/07/2007 |