Provider Demographics
NPI:1275314106
Name:GUM SPECIALTY CENTER
Entity Type:Organization
Organization Name:GUM SPECIALTY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABENA
Authorized Official - Middle Name:SALOME
Authorized Official - Last Name:OWUSU-FRIMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-813-4328
Mailing Address - Street 1:8604 CHATEAU AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2049
Mailing Address - Country:US
Mailing Address - Phone:718-813-4328
Mailing Address - Fax:
Practice Address - Street 1:1010 W EXCHANGE PKWY STE 1160
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7116
Practice Address - Country:US
Practice Address - Phone:469-663-0393
Practice Address - Fax:469-663-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty