Provider Demographics
NPI:1699836742
Name:GAZ, DAVID J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:GAZ
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 1:715 NOTTINGHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711
Mailing Address - Country:US
Mailing Address - Phone:302-525-6463
Mailing Address - Fax:302-525-6456
Practice Address - Street 1:715 NOTTINGHAM ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-525-6463
Practice Address - Fax:302-525-6456
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10001208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039458Medicaid