Provider Demographics
NPI:1356487789
Name:FUNARI, GARY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:FUNARI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 OLANDWOOD CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1485
Mailing Address - Country:US
Mailing Address - Phone:301-774-6200
Mailing Address - Fax:301-774-1272
Practice Address - Street 1:3401 OLANDWOOD CT
Practice Address - Street 2:SUITE 104
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1485
Practice Address - Country:US
Practice Address - Phone:301-774-6200
Practice Address - Fax:301-774-1272
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD98601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9860OtherMD LICENSE NUMBER