Individual
MR. JOSHUA ETHAN GISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
260 MIDDLE COUNTRY ROAD, BLDG 2, SUITE 12, SELDEN, NY 11784
(631) 696-9752
(631) 696-5096
Mailing address
260 MIDDLE COUNTRY ROAD, BLDG 2, SUITE 12, SELDEN, NY 11784
(631) 696-9752
(631) 696-5096
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
053598-1
NY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
053598
NY
Other
Enumeration date
02/24/2008
Last updated
10/11/2012
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