Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401004635 | VA |
NPI | 1003872326 |
---|---|
Provider Name | Dr. Gregory Taylor Gendron |
First Address | Martinsville, VA 24112 |
Second Address | Martinsville, VA 24112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7806981 | (05) | VA |