Provider Demographics
NPI:1780737775
Name:DEBEVOISE, GARY ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:DEBEVOISE
Suffix:
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 1:30 CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1312
Mailing Address - Country:US
Mailing Address - Phone:740-522-3161
Mailing Address - Fax:740-522-8490
Practice Address - Street 1:30 CUSTER RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1312
Practice Address - Country:US
Practice Address - Phone:740-522-3161
Practice Address - Fax:740-522-8490
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0143541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics