Provider Demographics
NPI:1598205197
Name:GAW FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GAW FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-268-2869
Mailing Address - Street 1:187 N GRUNDY QUARLES HWY
Mailing Address - Street 2:
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-9691
Mailing Address - Country:US
Mailing Address - Phone:931-268-2869
Mailing Address - Fax:931-268-9837
Practice Address - Street 1:187 N GRUNDY QUARLES HWY
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562-9691
Practice Address - Country:US
Practice Address - Phone:931-268-2869
Practice Address - Fax:931-268-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000033041223G0001X
TNDS00000095361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty