Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5751 | NE |
N | 122300000X | Dentist | 7490 | IA |
NPI | 1013012350 |
---|---|
Provider Name | Dr. Gregory L Garro |
First Address | Omaha, NE 68116-8262 |
Second Address | Omaha, NE 68116-8262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 15/08/2014 |