Provider Demographics
NPI:1952574980
Name:GAST, GARRY G (DDS)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:G
Last Name:GAST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1550 TIBURON BLVD
Mailing Address - Street 2:SUITE Y
Mailing Address - City:BELVEDERE TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2564
Mailing Address - Country:US
Mailing Address - Phone:415-435-0941
Mailing Address - Fax:415-435-1462
Practice Address - Street 1:1550 TIBURON BLVD
Practice Address - Street 2:SUITE Y
Practice Address - City:BELVEDERE TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-2564
Practice Address - Country:US
Practice Address - Phone:415-435-0941
Practice Address - Fax:415-435-1462
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA228001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics