1548713167 NPI number — CRAIG M. GAYTON DDS P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548713167 NPI number — CRAIG M. GAYTON DDS P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG M. GAYTON DDS P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548713167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3060 MITCHELLVILLE RD
Provider Second Line Business Mailing Address:
SUITE108
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20716-1389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-245-3174
Provider Business Mailing Address Fax Number:
888-784-1551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10801 LOCKWOOD DR
Provider Second Line Business Practice Location Address:
240
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20901-1556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-681-4812
Provider Business Practice Location Address Fax Number:
888-784-1551
Provider Enumeration Date:
08/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GAYTON
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-681-4812

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  12438 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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