Provider Demographics
NPI:1750498788
Name:BINTZ, GARY DEAN (DPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DEAN
Last Name:BINTZ
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 REVEILLE DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-4438
Mailing Address - Country:US
Mailing Address - Phone:580-762-4341
Mailing Address - Fax:580-767-8813
Practice Address - Street 1:1113 E HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2016
Practice Address - Country:US
Practice Address - Phone:580-765-3055
Practice Address - Fax:580-765-3410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist