Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 8917 | GA |
NPI | 1063515989 |
---|---|
Provider Name | Dr. Gerard Smith |
First Address | Savannah, GA 31406-3606 |
Second Address | Savannah, GA 31406-3606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |