Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4908 | AZ |
NPI | 1013006568 |
---|---|
Provider Name | Dr. Troy Gombert |
First Address | Chandler, AZ 85226-5940 |
Second Address | Chandler, AZ 85226-5940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |