Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401411130 | VA |
NPI | 1043354210 |
---|---|
Provider Name | Dr. Michael K Gazori |
First Address | Lansdowne, VA 20176-8446 |
Second Address | Lansdowne, VA 20176-8446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |