Individual
MICHELLE S GWYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1536 EISENHOWER PKWY, MACON, GA 31206-3130
(478) 781-4333
Mailing address
415 N GRAND AVE, PUEBLO, CO 81003-3111
(719) 546-3333
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013195
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9180516
—
GA
Enumeration date
02/18/2006
Last updated
07/09/2007
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