Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4091 | SC |
NPI | 1093726051 |
---|---|
Provider Name | Dr. George Gray Kitchens JR. |
First Address | Greer, SC 29650-3784 |
Second Address | Anderson, SC 29621-4767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |