Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 1158 | AZ |
NPI | 1003951161 |
---|---|
Provider Name | Dr. William Charles Gaylord |
First Address | Flagstaff, AZ 86001-3142 |
Second Address | Flagstaff, AZ 86001-3142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |