Provider Demographics
NPI:1205931391
Name:GWYNN, GEOFFREY ALLEN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:ALLEN
Last Name:GWYNN
Suffix:JR
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 1:120 WAYLAND SMITH DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-2677
Mailing Address - Country:US
Mailing Address - Phone:724-439-1170
Mailing Address - Fax:724-439-6011
Practice Address - Street 1:120 WAYLAND SMITH DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2677
Practice Address - Country:US
Practice Address - Phone:724-439-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030292L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist