Provider Demographics
NPI:1154503894
Name:CUMMINGS, GARY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:CUMMINGS
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 1:2302 BROWN RD.
Mailing Address - Street 2:CENTINELA STATE PRISON
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251
Mailing Address - Country:US
Mailing Address - Phone:760-337-7900
Mailing Address - Fax:
Practice Address - Street 1:2302 BROWN RD.
Practice Address - Street 2:CENTINELA STATE PRISON
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251
Practice Address - Country:US
Practice Address - Phone:760-337-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist