Provider Demographics
NPI:1114136926
Name:AARON, GAVIN MALCOLM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:MALCOLM
Last Name:AARON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 PETERS CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2738
Mailing Address - Country:US
Mailing Address - Phone:540-562-3166
Mailing Address - Fax:540-562-0760
Practice Address - Street 1:3005 PETERS CREEK RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-2738
Practice Address - Country:US
Practice Address - Phone:540-562-3166
Practice Address - Fax:540-562-0760
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics