=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902309974
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN ANN GEHRMAN R.D.H.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2018
-----------------------------------------------------
Last Update Date | 03/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 WAPPOO CREEK DR. SUITE #5 JAMES ISLAND DENTAL ASSOCIATES
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29412-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-762-1234
-----------------------------------------------------
Fax | 843-762-9142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 WAPPOO CREEK DR. SUITE #5 JAMES ISLAND DENTAL ASSOCIATES
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29412-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-762-1234
-----------------------------------------------------
Fax | 843-762-9142
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 2990
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------