Provider Demographics
NPI:1013010016
Name:TRUXTON, GARY JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOEL
Last Name:TRUXTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15710 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2517
Mailing Address - Country:US
Mailing Address - Phone:216-662-4028
Mailing Address - Fax:216-518-8138
Practice Address - Street 1:15710 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2517
Practice Address - Country:US
Practice Address - Phone:216-662-4028
Practice Address - Fax:216-518-8138
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice