Healthcare Provider Details

I. General information

NPI: 1437367695
Provider Name (Legal Business Name): GARY DEHM D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 NE 11TH ST
MADRAS OR
97741-1865
US

IV. Provider business mailing address

2777 NE RED OAK DR
BEND OR
97701-8348
US

V. Phone/Fax

Practice location:
  • Phone: 888-468-0022
  • Fax: 541-516-4071
Mailing address:
  • Phone: 541-550-9630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0026136
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8737
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: