MEDICARE: GUM SPECIALTY CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223D0004X	Dental Anesthesiology
2	1223E0200X	Endodontics
3	1223P0700X	Prosthodontics
4	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1275314106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUM SPECIALTY CENTER

Provider Business Mailing Address
First Line	:	8604 CHATEAU AVE
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-2049
Country	:	US
Telephone Number	:	718-813-4328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 W EXCHANGE PKWY STE 1160
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-7116
Country	:	US
Telephone Number	:	469-663-0393
Fax Number	:	469-663-0394

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ABENA SALOME OWUSU-FRIMPONG
Credential	:	DDS
Telephone Number	:	718-813-4328

Provider Enumeration Date	:	10/06/2023
Last Update Date	:	10/06/2023

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Directions to “GUM SPECIALTY CENTER ” Practice Location

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