Healthcare Provider Details

I. General information

NPI: 1245292416
Provider Name (Legal Business Name): GARY WAYNE GUREN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20508 SOUTHGATE PARK BLVD
MAPLE HEIGHTS OH
44137-2900
US

IV. Provider business mailing address

320 BLOSSOM LN
ORANGE VILLAGE OH
44022-5108
US

V. Phone/Fax

Practice location:
  • Phone: 216-663-2292
  • Fax: 216-663-2294
Mailing address:
  • Phone: 440-349-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14945
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: