Provider Demographics
NPI:1902002199
Name:GAWLEY, DANA ROBERT
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:ROBERT
Last Name:GAWLEY
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 1:2733 NW CHAMPION CIR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-8675
Mailing Address - Country:US
Mailing Address - Phone:530-798-3191
Mailing Address - Fax:
Practice Address - Street 1:217 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-0450
Practice Address - Country:US
Practice Address - Phone:541-826-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23437122300000X
ORD11221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist