Provider Demographics
NPI:1811086184
Name:NACK, GARY (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:NACK
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 1:120 BUCK RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1707
Mailing Address - Country:US
Mailing Address - Phone:215-364-6540
Mailing Address - Fax:215-396-6727
Practice Address - Street 1:120 BUCK RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-1707
Practice Address - Country:US
Practice Address - Phone:215-364-6540
Practice Address - Fax:215-396-6727
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-023524-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice