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Individual
DR. GORDON W WOMACK
Active
Individual
DR. GORDON W WOMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
17287
OH
122300000X
Dentist
DGD.9455GD
SC
1223P0221X
Pediatric Dentistry
17287
OH
1223P0221X
Pediatric Dentistry
Primary
DGD.2025DS
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0617587
—
OH
01
—
311367412
FED TAX ID
OH
Enumeration date
09/20/2006
Last updated
11/19/2024
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