Provider Demographics
NPI:1942394440
Name:WEISBLY, GARY (DMD, PLLC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:WEISBLY
Suffix:
Gender:M
Credentials:DMD, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12921 CANTRELL RD.
Mailing Address - Street 2:SUITE# 301
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1701
Mailing Address - Country:US
Mailing Address - Phone:501-224-5511
Mailing Address - Fax:501-224-2405
Practice Address - Street 1:12921 CANTRELL RD.
Practice Address - Street 2:SUITE# 301
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1701
Practice Address - Country:US
Practice Address - Phone:501-224-5511
Practice Address - Fax:501-224-2405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice