Provider Demographics
NPI:1437367695
Name:DEHM, GARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:DEHM
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 1:2777 NE RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8348
Mailing Address - Country:US
Mailing Address - Phone:541-550-9630
Mailing Address - Fax:
Practice Address - Street 1:48 NE 11TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1865
Practice Address - Country:US
Practice Address - Phone:888-468-0022
Practice Address - Fax:541-516-4071
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87371223G0001X
TX0026136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist