Individual
GRANT GASTINEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
32 W MAIN ST, CHANUTE, KS 66720-1701
(620) 431-4823
Mailing address
32 W MAIN ST, CHANUTE, KS 66720-1701
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61398
KS
1223G0001X
General Practice Dentistry
61398
KS
Other
Enumeration date
05/26/2017
Last updated
05/26/2017
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