Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0401006714 | VA |
NPI | 1114195989 |
---|---|
Provider Name | Dr. John C Gunsolley |
First Address | Richmond, VA 23298-5045 |
Second Address | Richmond, VA 23298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 14/02/2008 |