Provider Demographics
NPI:1639501273
Name:DR. L GARY PAINTER PC
Entity Type:Organization
Organization Name:DR. L GARY PAINTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:L. GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-486-3100
Mailing Address - Street 1:4109 LAHMEYER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5666
Mailing Address - Country:US
Mailing Address - Phone:260-486-3100
Mailing Address - Fax:260-486-0068
Practice Address - Street 1:4109 LAHMEYER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5666
Practice Address - Country:US
Practice Address - Phone:260-486-3100
Practice Address - Fax:260-486-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008216A122300000X
12011943A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty