Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | WV3117 | WV |
NPI | 1003020942 |
---|---|
Provider Name | Dr. Paul Gainer |
First Address | Clarksburg, WV 26301-9689 |
Second Address | Clarksburg, WV 26301-9689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |