Provider Demographics
NPI:1114197399
Name:GARY N GAITHER DDS
Entity Type:Organization
Organization Name:GARY N GAITHER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:GAITHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-873-8465
Mailing Address - Street 1:131 NORTH MULBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5135
Mailing Address - Country:US
Mailing Address - Phone:704-873-8465
Mailing Address - Fax:
Practice Address - Street 1:131 NORTH MULBERRY STREET
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5135
Practice Address - Country:US
Practice Address - Phone:704-873-8465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993031Medicaid