Individual
GINAMARIE KALLANSRUDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 BARBARA DR, FARMINGDALE, NY 11735-6102
(516) 993-3798
Mailing address
12 BARBARA DR, FARMINGDALE, NY 11735-6102
(516) 993-3798
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
018437-1
NY
Other
Enumeration date
04/27/2022
Last updated
04/27/2022
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