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NPI Code Detail

MEDICARE: MICHELLE S GWYN

MEDICARE: MICHELLE S GWYN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN013195GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023083631
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE S GWYN
Provider Business Mailing Address
First Line : 415 N GRAND AVE
Second Line :
City : PUEBLO
State : CO
Zip : 81003-3111
Country : US
Telephone Number : 719-546-3333
Fax Number :
Provider Business Practice Location Address
First Line : 1536 EISENHOWER PKWY
Second Line :
City : MACON
State : GA
Zip : 31206-3130
Country : US
Telephone Number : 478-781-4333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2006
Last Update Date : 07/09/2007

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