Provider Demographics
NPI:1922194026
Name:GAINZA, CRAIG S (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:GAINZA
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ROTARY WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8475
Mailing Address - Country:US
Mailing Address - Phone:707-642-4119
Mailing Address - Fax:707-642-7833
Practice Address - Street 1:27 ROTARY WAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8475
Practice Address - Country:US
Practice Address - Phone:707-642-4119
Practice Address - Fax:707-642-7833
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics