Provider Demographics
NPI:1811033103
Name:CARR, GARY B
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:CARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 LUSK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2731
Mailing Address - Country:US
Mailing Address - Phone:858-558-3636
Mailing Address - Fax:858-558-3633
Practice Address - Street 1:6235 LUSK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2731
Practice Address - Country:US
Practice Address - Phone:858-558-3636
Practice Address - Fax:858-558-3633
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271081223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics