MEDICARE: MARY C. GADDIS, DDS

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	261QD0000X	Dental Clinic/Center	7761	NC

General Provider Information

NPI Number	:	1154668630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY C. GADDIS, DDS

Provider Business Mailing Address
First Line	:	2003 E NC HIGHWAY 54
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-2482
Country	:	US
Telephone Number	:	919-484-8088
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 E NC HIGHWAY 54
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-2482
Country	:	US
Telephone Number	:	919-484-8088
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. MARY GADDIS
Credential	:	DDS
Telephone Number	:	919-484-8088

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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