Healthcare Provider Details

I. General information

NPI: 1053372789
Provider Name (Legal Business Name): GARY LEE DELAIR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: GARY LEE DELAIR DDS

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ELM ST
STOCKBRIDGE MA
01262
US

IV. Provider business mailing address

PO BOX 298
STOCKBRIDGE MA
01262
US

V. Phone/Fax

Practice location:
  • Phone: 413-298-3717
  • Fax: 413-298-4203
Mailing address:
  • Phone: 413-298-3717
  • Fax: 413-298-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13950
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: