Provider Demographics
NPI:1033423934
Name:GARY, DAVID W (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:GARY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:D
Other - Middle Name:WILLIAM
Other - Last Name:GARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1419 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3049
Mailing Address - Country:US
Mailing Address - Phone:915-207-6496
Mailing Address - Fax:
Practice Address - Street 1:1419 PARKWAY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3049
Practice Address - Country:US
Practice Address - Phone:915-207-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25687122300000X
TN10008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist