Provider Demographics
NPI:1760499255
Name:DRURY, GARY L
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:DRURY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W BRISTOL ST
Mailing Address - Street 2:SUITE ABC-1
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 W BRISTOL ST
Practice Address - Street 2:SUITE ABC-1
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2954
Practice Address - Country:US
Practice Address - Phone:574-264-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007918A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist