Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 06983 | IA |
NPI | 1225197908 |
---|---|
Provider Name | Richard Gilbert Schrage |
First Address | Yuma, AZ 85366-1368 |
Second Address | Winterhaven, CA 92283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |