Provider Demographics
NPI:1700070703
Name:DIAL, GINGER BETH (NASM)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:BETH
Last Name:DIAL
Suffix:
Gender:F
Credentials:NASM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-3778
Mailing Address - Country:US
Mailing Address - Phone:573-356-6700
Mailing Address - Fax:
Practice Address - Street 1:3612 VALENCIA DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3778
Practice Address - Country:US
Practice Address - Phone:573-356-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-02
Last Update Date:2007-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0798845174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist