Provider Demographics
NPI:1295856763
Name:GAVIN, WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:GAVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6949 VALLEY CREEK RD
Mailing Address - Street 2:#130
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2253
Mailing Address - Country:US
Mailing Address - Phone:651-732-1630
Mailing Address - Fax:651-731-1635
Practice Address - Street 1:6949 VALLEY CREEK RD
Practice Address - Street 2:#130
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2253
Practice Address - Country:US
Practice Address - Phone:651-731-1630
Practice Address - Fax:651-731-1635
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics