Provider Demographics
NPI:1780894584
Name:BRUCE A. GASTON, D.D.S.
Entity type:Organization
Organization Name:BRUCE A. GASTON, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-609-9196
Mailing Address - Street 1:1911 MALVERN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-609-9196
Mailing Address - Fax:501-609-9148
Practice Address - Street 1:1911 MALVERN AVE
Practice Address - Street 2:STE A
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:501-609-9196
Practice Address - Fax:501-609-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty