Provider Demographics
NPI:1609894682
Name:ZEIDLER, GARY R (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:ZEIDLER
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 1:5150 GRAVES AVE
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5013
Mailing Address - Country:US
Mailing Address - Phone:408-257-3530
Mailing Address - Fax:408-257-0341
Practice Address - Street 1:5150 GRAVES AVE
Practice Address - Street 2:SUITE 10A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5013
Practice Address - Country:US
Practice Address - Phone:408-257-3530
Practice Address - Fax:408-257-0341
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice