Provider Demographics
NPI:1598802472
Name:GAW, TED W (DDS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:W
Last Name:GAW
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 1:240 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-5538
Mailing Address - Country:US
Mailing Address - Phone:931-268-2597
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000033041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0026412OtherBLUE CROSS BLUE SHIELD