Provider Demographics
NPI:1679817241
Name:GNEITING, DEVIN THEODORE (DMD)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:THEODORE
Last Name:GNEITING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 WOODWAY DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6102
Mailing Address - Country:US
Mailing Address - Phone:254-753-0313
Mailing Address - Fax:254-753-0315
Practice Address - Street 1:7124 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6102
Practice Address - Country:US
Practice Address - Phone:254-753-0313
Practice Address - Fax:254-753-0315
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice