MEDICARE: DR. GARRY G. GAST 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22800	CA

General Provider Information

NPI Number	:	1952574980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRY G. GAST D.D.S.

Provider Business Mailing Address
First Line	:	1550 TIBURON BLVD
Second Line	:	SUITE Y
City	:	BELVEDERE TIBURON
State	:	CA
Zip	:	94920-2564
Country	:	US
Telephone Number	:	415-435-0941
Fax Number	:	415-435-1462

Provider Business Practice Location Address
First Line	:	1550 TIBURON BLVD
Second Line	:	SUITE Y
City	:	BELVEDERE TIBURON
State	:	CA
Zip	:	94920-2564
Country	:	US
Telephone Number	:	415-435-0941
Fax Number	:	415-435-1462

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

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	04/10/2008

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