=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548473242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARY D. BEHREND, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5710 SIX FORKS RD SUITE 101
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-8617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-866-1989
-----------------------------------------------------
Fax | 919-866-0468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5710 SIX FORKS RD SUITE 101
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-8617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-866-1989
-----------------------------------------------------
Fax | 919-866-0468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GARY D BEHREND
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 919-866-1989
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 5745
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------