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General NPI Number Information
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NPI Number | 1275314106
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Entity Type | Organization
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Legal Business Name | GUM SPECIALTY CENTER
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 1010 W EXCHANGE PKWY STE 1160
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City | ALLEN
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State | TX
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Zip | 75013-7116
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Country | US
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Telephone | 469-663-0393
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Fax | 469-663-0394
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Provider Business Mailing Address
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Address Line | 8604 CHATEAU AVE
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City | MCKINNEY
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State | TX
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Zip | 75071-2049
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Country | US
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Telephone | 718-813-4328
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ABENA SALOME OWUSU-FRIMPONG
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Credential | DDS
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Telephone | 718-813-4328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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