Provider Demographics
NPI:1972693976
Name:MACY, GERARD THOMAS (DDS)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:THOMAS
Last Name:MACY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GERARD
Other - Middle Name:THOMAS
Other - Last Name:MACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:507 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-8328
Mailing Address - Country:US
Mailing Address - Phone:903-603-4406
Mailing Address - Fax:
Practice Address - Street 1:507 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-8328
Practice Address - Country:US
Practice Address - Phone:903-603-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice