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General NPI Number Information
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NPI Number | 1154668630
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Entity Type | Organization
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Legal Business Name | MARY C. GADDIS, DDS
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 2003 E NC HIGHWAY 54
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City | DURHAM
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State | NC
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Zip | 27713-2482
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Country | US
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Telephone | 919-484-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 2003 E NC HIGHWAY 54
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City | DURHAM
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State | NC
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Zip | 27713-2482
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Country | US
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Telephone | 919-484-8088
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. MARY GADDIS
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Credential | DDS
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Telephone | 919-484-8088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7761
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License Number State | NC
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