Provider Demographics
NPI:1588654461
Name:JENNINGS, GARY STEPHEN (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:STEPHEN
Last Name:JENNINGS
Suffix:
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 1:4515 VAN WINKLE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:806-358-0368
Mailing Address - Fax:806-351-1744
Practice Address - Street 1:4515 VAN WINKLE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-358-0368
Practice Address - Fax:806-351-1744
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist