Provider Demographics
NPI:1831252618
Name:VERIGIN, GARY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:VERIGIN
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:PO BOX 128
Mailing Address - Street 2:1415 OKLAHOMA AVE
Mailing Address - City:ESCALON
Mailing Address - State:CA
Mailing Address - Zip Code:95320
Mailing Address - Country:US
Mailing Address - Phone:209-838-3522
Mailing Address - Fax:209-838-2460
Practice Address - Street 1:1415 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320
Practice Address - Country:US
Practice Address - Phone:209-838-3522
Practice Address - Fax:209-838-2460
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA186581223G0001X
WA000034121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice