Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 35048093G | OH |
NPI | 1275618316 |
---|---|
Provider Name | Richard D Gentile |
First Address | Youngstown, OH 44512-5061 |
Second Address | Youngstown, OH 44512-5061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0666837 | (05) | OH |
A17158 | (02) | OH |