Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTR 5528 | ME |
NPI | 1134652142 |
---|---|
Provider Name | Gary Hughes |
First Address | Presque Isle, ME 04769-2656 |
Second Address | Presque Isle, ME 04769-2656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2017 |
Last Update Date | 06/04/2017 |