Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3493 | WV |
NPI | 1083787097 |
---|---|
Provider Name | Dr. Lori L Gochenour |
First Address | Martinsburg, WV 25401 |
Second Address | Martinsburg, WV 25401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |