Provider Demographics
NPI:1689699084
Name:DESALVO, GARY JOSEPH (DMD MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOSEPH
Last Name:DESALVO
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3903
Mailing Address - Country:US
Mailing Address - Phone:336-884-8771
Mailing Address - Fax:336-884-8770
Practice Address - Street 1:901 N LINDSAY ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3903
Practice Address - Country:US
Practice Address - Phone:336-884-8771
Practice Address - Fax:336-884-8770
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-007731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992141Medicaid
NCG01351Medicare UPIN
NC8992141Medicaid