Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN17804 | FL |
NPI | 1063547545 |
---|---|
Provider Name | Dr. Rose Martine Gedeon |
First Address | Naples, FL 34119-7953 |
Second Address | Immokalee, FL 34142-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 24/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0767200400 | (05) | FL |