Provider Demographics
NPI:1861503138
Name:NAYLOR, GARY GRANT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:GRANT
Last Name:NAYLOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 402
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-9715
Mailing Address - Country:US
Mailing Address - Phone:304-329-2682
Mailing Address - Fax:
Practice Address - Street 1:202 TUNNELTON ST STE 214
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1452
Practice Address - Country:US
Practice Address - Phone:304-329-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135772001Medicaid