Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11583 | MD |
NPI | 1013041425 |
---|---|
Provider Name | Dr. Stephen Micheal Gant SR. |
First Address | Columbia, MD 21044-3629 |
Second Address | Columbia, MD 21044-3629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |