Provider Demographics
NPI:1558839530
Name:GAYNIER ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:GAYNIER ORTHODONTICS PLLC
Other - Org Name:GAYNIER ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-581-8152
Mailing Address - Street 1:824 E REDD RD STE 1-A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7262
Mailing Address - Country:US
Mailing Address - Phone:915-581-8152
Mailing Address - Fax:
Practice Address - Street 1:824 E REDD RD STE 1-A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7262
Practice Address - Country:US
Practice Address - Phone:915-581-8152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty