Provider Demographics
NPI:1821291873
Name:GARY J WAYNE DMD PA
Entity Type:Organization
Organization Name:GARY J WAYNE DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JON
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-443-7001
Mailing Address - Street 1:2500 N MILITARY TRL
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6344
Mailing Address - Country:US
Mailing Address - Phone:561-443-7001
Mailing Address - Fax:561-443-7087
Practice Address - Street 1:2500 N MILITARY TRL
Practice Address - Street 2:SUITE 308
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6344
Practice Address - Country:US
Practice Address - Phone:561-443-7001
Practice Address - Fax:561-443-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL134031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty