Provider Demographics
NPI:1265436992
Name:MOBLEY, GARY (DDS, MSC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:DDS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 EISENHOWER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:903-463-6013
Mailing Address - Fax:903-463-1442
Practice Address - Street 1:2230 EISENHOWER PARKWAY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:903-463-6013
Practice Address - Fax:903-463-1442
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-04-14
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TXTX96901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics