Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2696-92 | MS |
NPI | 1073611620 |
---|---|
Provider Name | Dr. Joseph Chet Gatewood |
First Address | Clinton, MS 39056-4193 |
Second Address | Clinton, MS 39056-4193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00660116 | (05) | MS |