Provider Demographics
NPI:1023176500
Name:MACKEY, GARY JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOHN
Last Name:MACKEY
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 1:2749 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8751
Mailing Address - Country:US
Mailing Address - Phone:714-639-3723
Mailing Address - Fax:714-639-1325
Practice Address - Street 1:2749 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8751
Practice Address - Country:US
Practice Address - Phone:714-639-3723
Practice Address - Fax:714-639-1325
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD200731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice