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General NPI Number Information
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NPI Number | 1629210174
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Entity Type | Organization
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Legal Business Name | GASTON FAMILY HEALTH SERVICES DENTAL
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 991 W HUDSON BLVD
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City | GASTONIA
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State | NC
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Zip | 28052-6430
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Country | US
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Telephone | 704-853-5079
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Fax |
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Provider Business Mailing Address
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Address Line | 991 W HUDSON BLVD
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City | GASTONIA
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State | NC
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Zip | 28052-6430
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Country | US
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Telephone | 704-853-5079
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT SPENCER
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Credential | MPH
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Telephone | 704-853-5261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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