Individual
KENNY GASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12158 CENTRAL AVE, MITCHELLVILLE, MD 20721-1932
(301) 430-2750
Mailing address
1306 TWIG TER, SILVER SPRING, MD 20905-7038
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/19/2018
Last updated
10/19/2018
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