MEDICARE: DR. MARY VERONICA COFFEY GADDIS D.D.S.

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	122300000X	Dentist	7761	NC

General Provider Information

NPI Number	:	1780801720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY VERONICA COFFEY GADDIS D.D.S.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	01/03/2013

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