Healthcare Provider Details

I. General information

NPI: 1275314106
Provider Name (Legal Business Name): GUM SPECIALTY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W EXCHANGE PKWY STE 1160
ALLEN TX
75013-7116
US

IV. Provider business mailing address

8604 CHATEAU AVE
MCKINNEY TX
75071-2049
US

V. Phone/Fax

Practice location:
  • Phone: 469-663-0393
  • Fax: 469-663-0394
Mailing address:
  • Phone: 718-813-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ABENA SALOME OWUSU-FRIMPONG
Title or Position: OWNER
Credential: DDS
Phone: 718-813-4328