Provider Demographics
NPI:1093728479
Name:GISCH, GARY RAYMOND (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:RAYMOND
Last Name:GISCH
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 1:1427 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4896
Mailing Address - Country:US
Mailing Address - Phone:903-885-3031
Mailing Address - Fax:903-885-7144
Practice Address - Street 1:1427 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4896
Practice Address - Country:US
Practice Address - Phone:903-885-3031
Practice Address - Fax:903-885-7144
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76336OtherUNITED CONCORDIA