Provider Demographics
NPI:1407974025
Name:ACKERMAN, GARY RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RAY
Last Name:ACKERMAN
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 1:6600 MADISON AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0645
Mailing Address - Country:US
Mailing Address - Phone:916-961-5464
Mailing Address - Fax:916-961-5927
Practice Address - Street 1:6600 MADISON AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0645
Practice Address - Country:US
Practice Address - Phone:916-961-5464
Practice Address - Fax:916-961-5927
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist