Organization
GORDON W WOMACK DDS INC
Active
Other names
Beavercreek Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON W WOMMACK DDS (OWNER)
(937) 426-2653
Entity
Organization
Contact information
Practice address
3300 KEMP ROAD, BEAVERCREEK, OH 45431
(937) 426-2653
(937) 426-1124
Mailing address
3300 KEMP ROAD, BEAVERCREEK, OH 45431
(937) 426-2653
(937) 426-1124
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
17287
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0617587
—
OH
Enumeration date
01/18/2007
Last updated
07/22/2008
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