Healthcare Provider Details

I. General information

NPI: 1114937729
Provider Name (Legal Business Name): EDWARD KENNETH GAMSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 OLD GEORGETOWN RD SUITE 405
BETHESDA MD
20814-1911
US

IV. Provider business mailing address

10401 OLD GEORGETOWN RD SUITE 405
BETHESDA MD
20814-1911
US

V. Phone/Fax

Practice location:
  • Phone: 301-493-4496
  • Fax: 301-493-4165
Mailing address:
  • Phone: 301-493-4496
  • Fax: 301-493-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9382
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: