Provider Demographics
NPI:1356496236
Name:GARY A. DEBEVOISE,D.D.S.,INC.
Entity Type:Organization
Organization Name:GARY A. DEBEVOISE,D.D.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DEBEVOISE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-522-3161
Mailing Address - Street 1:30 CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1312
Mailing Address - Country:US
Mailing Address - Phone:740-522-3161
Mailing Address - Fax:740-522-8490
Practice Address - Street 1:30 CUSTER RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1312
Practice Address - Country:US
Practice Address - Phone:740-522-3161
Practice Address - Fax:740-522-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-014354261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental