Provider Demographics
NPI:1659651347
Name:BIEDERMANN, GINA ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:ANTHONY
Last Name:BIEDERMANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 KELLER PKWY # 111
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3611
Mailing Address - Country:US
Mailing Address - Phone:817-421-1470
Mailing Address - Fax:
Practice Address - Street 1:1000 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3611
Practice Address - Country:US
Practice Address - Phone:817-421-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice