Provider Demographics
NPI:1700932217
Name:HAILEY, GARY L (DDS MS PA)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:HAILEY
Suffix:
Gender:M
Credentials:DDS MS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17201 FEATHERCRAFT LANE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-486-6905
Mailing Address - Fax:281-486-7514
Practice Address - Street 1:17201 FEATHERCRAFT LANE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-486-6905
Practice Address - Fax:281-486-7514
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics