Provider Demographics
NPI:1457481301
Name:OYSTER, GARY DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DONALD
Last Name:OYSTER
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 1:5621 DEPARTURE DRIVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-1911
Mailing Address - Country:US
Mailing Address - Phone:919-876-2087
Mailing Address - Fax:919-981-0382
Practice Address - Street 1:5621 DEPARTURE DRIVE
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1911
Practice Address - Country:US
Practice Address - Phone:919-876-2087
Practice Address - Fax:919-981-0382
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996572Medicaid