MEDICARE: DR. DAVID W. GANN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4699	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003910399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID W. GANN D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1020
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-1020
Country	:	US
Telephone Number	:	334-683-6997
Fax Number	:	334-683-9159

Provider Business Practice Location Address
First Line	:	10081 HIGHWAY 5 S
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-3441
Country	:	US
Telephone Number	:	334-683-6997
Fax Number	:	334-683-9159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	03/06/2025

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