Provider Demographics
NPI:1902824907
Name:CHOW, GARY WENDELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WENDELL
Last Name:CHOW
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 1:10900 WARNER AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3846
Mailing Address - Country:US
Mailing Address - Phone:714-968-1648
Mailing Address - Fax:714-965-9227
Practice Address - Street 1:10900 WARNER AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3846
Practice Address - Country:US
Practice Address - Phone:714-968-1648
Practice Address - Fax:714-965-9227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice