Provider Demographics
NPI:1518086875
Name:ALBRIGHT, GARY R (DMD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:ALBRIGHT
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 1:15600 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1467
Mailing Address - Country:US
Mailing Address - Phone:510-276-7124
Mailing Address - Fax:510-276-7132
Practice Address - Street 1:15600 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-1467
Practice Address - Country:US
Practice Address - Phone:510-276-7124
Practice Address - Fax:510-276-7132
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice