Provider Demographics
NPI:1073622262
Name:GADDIS, DAVID BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BENJAMIN
Last Name:GADDIS
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:PO BOX 307
Mailing Address - Street 2:14 NORTH ASHE AVE
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-0307
Mailing Address - Country:US
Mailing Address - Phone:828-464-1732
Mailing Address - Fax:828-464-1963
Practice Address - Street 1:14 N ASHE AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3229
Practice Address - Country:US
Practice Address - Phone:828-464-1732
Practice Address - Fax:828-464-1963
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice