Provider Demographics
NPI:1952371502
Name:ASANO, GARY Y (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:Y
Last Name:ASANO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 W FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2665
Mailing Address - Country:US
Mailing Address - Phone:906-228-6442
Mailing Address - Fax:906-228-2733
Practice Address - Street 1:1055 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2665
Practice Address - Country:US
Practice Address - Phone:906-228-6442
Practice Address - Fax:906-228-2733
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI129391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics