Healthcare Provider Details

I. General information

NPI: 1447559828
Provider Name (Legal Business Name): DARRIELLE LYNNE STICKLER GATSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GIRARD ST SUITE 206
GAITHERSBURG MD
20877-3466
US

IV. Provider business mailing address

15850 CRABBS BRANCH WAY SUITE 350
ROCKVILLE MD
20855-2622
US

V. Phone/Fax

Practice location:
  • Phone: 240-720-0510
  • Fax: 240-631-2280
Mailing address:
  • Phone: 240-499-2636
  • Fax: 240-499-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5881
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: