Provider Demographics
NPI:1598965691
Name:CHESTER J. GARY, DDS AND MARK D. POWALSKI, DDS, PC
Entity Type:Organization
Organization Name:CHESTER J. GARY, DDS AND MARK D. POWALSKI, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-683-7443
Mailing Address - Street 1:2197 GEORGE URBAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1960
Mailing Address - Country:US
Mailing Address - Phone:716-683-7443
Mailing Address - Fax:716-684-3597
Practice Address - Street 1:2197 GEORGE URBAN BLVD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1960
Practice Address - Country:US
Practice Address - Phone:716-683-7443
Practice Address - Fax:716-684-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33932122300000X
NY41403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty