Healthcare Provider Details

I. General information

NPI: 1902002199
Provider Name (Legal Business Name): DR. DANA ROBERT GAWLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 01/04/2026
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W MAIN ST
EAGLE POINT OR
97524-0450
US

IV. Provider business mailing address

2733 NW CHAMPION CIR
BEND OR
97703-8675
US

V. Phone/Fax

Practice location:
  • Phone: 541-826-2525
  • Fax:
Mailing address:
  • Phone: 530-798-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number23437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11221
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: