Healthcare Provider Details

I. General information

NPI: 1871611632
Provider Name (Legal Business Name): DONALD GASS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 N DOBSON RD 32-B
CHANDLER AZ
85224-4226
US

IV. Provider business mailing address

595 N DOBSON RD 32-B
CHANDLER AZ
85224-4226
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-8893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3318
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: