Provider Demographics
NPI:1447559828
Name:STICKLER GATSON, DARRIELLE LYNNE (RDH)
Entity Type:Individual
Prefix:MS
First Name:DARRIELLE
Middle Name:LYNNE
Last Name:STICKLER GATSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15850 CRABBS BRANCH WAY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2622
Mailing Address - Country:US
Mailing Address - Phone:240-499-2636
Mailing Address - Fax:240-499-2602
Practice Address - Street 1:200 GIRARD ST
Practice Address - Street 2:SUITE 206
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3466
Practice Address - Country:US
Practice Address - Phone:240-720-0510
Practice Address - Fax:240-631-2280
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD5881124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist