Individual
DR. MICHAEL HASKINS GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
14245P CENTREVILLE SQ, CENTREVILLE, VA 20121
(703) 830-9110
(703) 830-1632
Mailing address
14245P CENTREVILLE SQ, CENTREVILLE, VA 20121
(703) 830-9110
(703) 830-1632
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9178685
—
VA
Enumeration date
07/31/2006
Last updated
07/08/2007
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