Provider Demographics
NPI:1013963602
Name:GAWRYCH, CONNIE D (DDS)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:D
Last Name:GAWRYCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:D
Other - Last Name:HEMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6064 BRIDGEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-5623
Mailing Address - Country:US
Mailing Address - Phone:513-248-1011
Mailing Address - Fax:
Practice Address - Street 1:121 E MCMILLAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2606
Practice Address - Country:US
Practice Address - Phone:513-721-2444
Practice Address - Fax:513-721-2398
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH88821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice