Provider Demographics
NPI:1356422919
Name:DEWOOD, GARY M (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:DEWOOD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 E PRINCESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9602
Mailing Address - Country:US
Mailing Address - Phone:480-588-9108
Mailing Address - Fax:
Practice Address - Street 1:7201 E PRINCESS BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-9602
Practice Address - Country:US
Practice Address - Phone:480-588-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8193122300000X
AZ7875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist