Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist |
NPI | 1285783605 |
---|---|
Provider Name | Mr. Gareth Thomas Coward |
First Address | Auburn, ME 04210 |
Second Address | Auburn, ME 04210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |