Provider Demographics
NPI:1457542409
Name:NATAUPSKY, GARY MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARK
Last Name:NATAUPSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:575 PIERCE STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5700
Mailing Address - Country:US
Mailing Address - Phone:570-331-8100
Mailing Address - Fax:570-714-8100
Practice Address - Street 1:575 PIERCE STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5700
Practice Address - Country:US
Practice Address - Phone:570-331-8100
Practice Address - Fax:570-714-8100
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021365L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist