Provider Demographics
NPI:1225200272
Name:TOUS, GARRY S (DDS)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:S
Last Name:TOUS
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 1:1222 BLUE SKY DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7974
Mailing Address - Country:US
Mailing Address - Phone:704-439-7954
Mailing Address - Fax:
Practice Address - Street 1:1222 BLUE SKY DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7974
Practice Address - Country:US
Practice Address - Phone:704-439-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83461223G0001X
CA236781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913127Medicaid