Provider Demographics
NPI:1841598588
Name:BERNARD R. GAVRON D.D.S., P.C.
Entity Type:Organization
Organization Name:BERNARD R. GAVRON D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GAVRON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-988-7356
Mailing Address - Street 1:465 ST. MICHAELS DR.
Mailing Address - Street 2:STE 208
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-988-7356
Mailing Address - Fax:505-992-8950
Practice Address - Street 1:465 ST. MICHAELS DR.
Practice Address - Street 2:STE 208
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-988-7356
Practice Address - Fax:505-992-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD16021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty