Provider Demographics
NPI:1558622894
Name:GARY F MAPES DDS PA
Entity Type:Organization
Organization Name:GARY F MAPES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAPES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-297-6022
Mailing Address - Street 1:2800 GILMER RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 GILMER RD
Practice Address - Street 2:SUITE #1
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1824
Practice Address - Country:US
Practice Address - Phone:903-297-6022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13912122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty