Provider Demographics
NPI:1609929298
Name:WAITE, GARY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:WAITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5500 SKYLINE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1772
Mailing Address - Country:US
Mailing Address - Phone:302-239-8586
Mailing Address - Fax:302-239-0671
Practice Address - Street 1:5500 SKYLINE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1772
Practice Address - Country:US
Practice Address - Phone:302-239-8586
Practice Address - Fax:302-239-0671
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DE8581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice