Provider Demographics
NPI:1578753018
Name:SURMAN, GARY JOSEPH SR (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:JOSEPH
Last Name:SURMAN
Suffix:SR
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 1:106 DIVISION ST
Mailing Address - Street 2:P.O. BOX 207
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-4605
Mailing Address - Country:US
Mailing Address - Phone:518-234-4365
Mailing Address - Fax:518-234-4366
Practice Address - Street 1:106 DIVISION ST
Practice Address - Street 2:SUITE 1
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-4605
Practice Address - Country:US
Practice Address - Phone:518-234-4365
Practice Address - Fax:518-234-4366
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0297071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00526701Medicaid