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General NPI Number Information
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NPI Number | 1942374491
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Entity Type | Individual
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Provider Name | ROBERT C. GAUDRY D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1718 S. MILLENIUM WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1511
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Country | US
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Telephone | 208-887-1053
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Fax | 208-884-5346
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Provider Business Mailing Address
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Address Line | 1718 S. MILLENIUM WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1511
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Country | US
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Telephone | 208-887-1053
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Fax | 208-884-5346
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D-1954-OR
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License Number State | ID
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