Provider Demographics
NPI:1093880502
Name:O'SHEA, GARY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:O'SHEA
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 1:2130 WELCHPOOLE CT
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-2701
Mailing Address - Country:US
Mailing Address - Phone:410-257-6816
Mailing Address - Fax:
Practice Address - Street 1:284 MERRIMAC COURT
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-2011
Practice Address - Fax:410-535-6344
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD84731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice