Provider Demographics
NPI:1063032357
Name:GASKILL, CYNTHIA RAE (PHRDH, MAE)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RAE
Last Name:GASKILL
Suffix:
Gender:F
Credentials:PHRDH, MAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 W HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-5303
Mailing Address - Country:US
Mailing Address - Phone:402-631-8742
Mailing Address - Fax:402-461-2477
Practice Address - Street 1:550 TECHNICAL BLVD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-8362
Practice Address - Country:US
Practice Address - Phone:402-461-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE624124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist