Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | L443857 | MI |
NPI | 1023414240 |
---|---|
Provider Name | Hana Gadalla |
First Address | Detroit, MI 48208-2576 |
Second Address | Detroit, MI 48208-2576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2014 |
Last Update Date | 16/11/2014 |