Provider Demographics
NPI:1619186293
Name:SENK, GARY PETER (DD,S)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:PETER
Last Name:SENK
Suffix:
Gender:M
Credentials:DD,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 N KROME AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6047
Mailing Address - Country:US
Mailing Address - Phone:305-247-2143
Mailing Address - Fax:305-247-2145
Practice Address - Street 1:381 N KROME AVE STE 209
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6047
Practice Address - Country:US
Practice Address - Phone:305-247-2143
Practice Address - Fax:305-247-2145
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist