Provider Demographics
NPI:1568562510
Name:MACHIKO, GARY WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
Last Name:MACHIKO
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 1:9380 MCKNIGHT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237
Mailing Address - Country:US
Mailing Address - Phone:412-367-1319
Mailing Address - Fax:412-630-9267
Practice Address - Street 1:9380 MCKNIGHT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-367-1319
Practice Address - Fax:412-630-9267
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS22945L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice