Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Ambulatory Surgical |
261QA1903X | 49 | Ambulatory Surgical Center |
| NPI Number | 1902287469 |
| LBN Legal business name | GATEWAY DENTAL SURGERY CENTER |
| Authorized official | KEVIN BOIE - (CFO) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 06/10/2015 |
| Last updated | 06/10/2015 - About 11 years ago |
| Identifiers | n/a |
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