Provider Demographics
NPI:1417413360
Name:GARY C. VERAGHEN, DDS, PC
Entity Type:Organization
Organization Name:GARY C. VERAGHEN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:VERAGHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-563-5855
Mailing Address - Street 1:22100 W. OUTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-563-5855
Mailing Address - Fax:313-563-5865
Practice Address - Street 1:22100 W. OUTER DRIVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-563-5855
Practice Address - Fax:313-563-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty