Organization Name: | LYNN E GASSOWAY,DDS,INC |
NPI Number: | 1104039510 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LYNN ELISE GASSOWAY (PRESIDENT) |
Mailing Address: | 8412 Maple Ave Gary |
State: | IN US |
Postal Code: | 464031419 |
Phone Number: | 2199382875 |
Fax Number: | 2199382875 |
NPI Enumeration Date: | 05/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 12007149 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |