Provider Demographics
NPI:1003897182
Name:GAVRON, BERNARD RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:RAY
Last Name:GAVRON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:465 SAINT MICHAELS DR
Mailing Address - Street 2:STE 208
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7670
Mailing Address - Country:US
Mailing Address - Phone:505-988-7356
Mailing Address - Fax:505-992-8950
Practice Address - Street 1:465 SAINT MICHAELS DR
Practice Address - Street 2:STE 208
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7670
Practice Address - Country:US
Practice Address - Phone:505-988-7356
Practice Address - Fax:505-992-8950
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMD16201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics