Provider Demographics
NPI:1669683595
Name:DRGAC, L.LAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:L.LAYNE
Middle Name:
Last Name:DRGAC
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 1:602 N GRAY ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836-1111
Mailing Address - Country:US
Mailing Address - Phone:979-567-3273
Mailing Address - Fax:
Practice Address - Street 1:602 N GRAY ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-1111
Practice Address - Country:US
Practice Address - Phone:979-567-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice