Provider Demographics
NPI:1275531774
Name:MCDONALD, GARY WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WAYNE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2300 GREEN OAK DR
Mailing Address - Street 2:SUITE # 600
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2048
Mailing Address - Country:US
Mailing Address - Phone:281-358-2002
Mailing Address - Fax:281-358-3855
Practice Address - Street 1:2300 GREEN OAK DR
Practice Address - Street 2:SUITE # 600
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2048
Practice Address - Country:US
Practice Address - Phone:281-358-2002
Practice Address - Fax:281-358-3855
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD11442Medicare PIN
TXT14709Medicare UPIN