Facts
- Status
- A
- Credential
- DDS
- Type
- Individual
- Enumeration date
- 2006-11-09
- Last updated
- 2007-07-08
Specialties
Licenses
- License OH
- OH 30-01224
Location
- Practice location
- 310 SILVER BRIDGE PLAZA
- City
- GALLIPOLIS OH
- Postal code
- 45631
- Phone
- 740-446-7010
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.