Provider Demographics
NPI:1508029430
Name:LAINE, GARY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:LAINE
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 1:850 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2923
Mailing Address - Country:US
Mailing Address - Phone:650-322-4750
Mailing Address - Fax:650-322-0703
Practice Address - Street 1:850 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2923
Practice Address - Country:US
Practice Address - Phone:650-322-4750
Practice Address - Fax:650-322-0703
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23406122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist