Provider Demographics
NPI:1841453743
Name:TRAYLOR, GWENDOLYN A (DDS)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:A
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 S DIXIE FWY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7473
Mailing Address - Country:US
Mailing Address - Phone:386-428-3228
Mailing Address - Fax:
Practice Address - Street 1:1119 S DIXIE FWY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7473
Practice Address - Country:US
Practice Address - Phone:386-428-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15674122300000X
NV6273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist