Provider Demographics
NPI:1578065785
Name:FAVRE, GERALD WILLIAM III (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WILLIAM
Last Name:FAVRE
Suffix:III
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 1:121 E SECOND ST
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-4442
Mailing Address - Country:US
Mailing Address - Phone:228-254-1212
Mailing Address - Fax:
Practice Address - Street 1:121 E SECOND ST
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-4442
Practice Address - Country:US
Practice Address - Phone:228-697-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-03
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS4233-21122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program