Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 9382 | MD |
NPI | 1114937729 |
---|---|
Provider Name | Edward Kenneth Gamson |
First Address | Bethesda, MD 20814-1911 |
Second Address | Bethesda, MD 20814-1911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |