Provider Demographics
NPI:1497837710
Name:GIDDINGS, JERRY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:R
Last Name:GIDDINGS
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 1:703 SLEATER-KINNEY RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-491-7888
Mailing Address - Fax:360-493-0573
Practice Address - Street 1:703 SLEATER-KINNEY RD
Practice Address - Street 2:SUITE H
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-491-7888
Practice Address - Fax:360-493-0573
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA62071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice