Provider Demographics
NPI:1922421379
Name:GLADYS K.GESICHO DDS INC
Entity Type:Organization
Organization Name:GLADYS K.GESICHO DDS INC
Other - Org Name:HAWKEYE FAMILY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:KWAMBOKA
Authorized Official - Last Name:GESICHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-632-2082
Mailing Address - Street 1:711 E HAWKEYE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-7505
Mailing Address - Country:US
Mailing Address - Phone:209-632-2082
Mailing Address - Fax:209-632-2357
Practice Address - Street 1:711 E HAWKEYE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-7505
Practice Address - Country:US
Practice Address - Phone:209-632-2082
Practice Address - Fax:209-632-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty