Provider Demographics
NPI:1255591517
Name:DENNINGTON, GARY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
Last Name:DENNINGTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 EAST LINCOLN ROAD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7349
Mailing Address - Country:US
Mailing Address - Phone:580-286-3051
Mailing Address - Fax:580-286-6960
Practice Address - Street 1:1510 EAST LINCOLN ROAD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7349
Practice Address - Country:US
Practice Address - Phone:580-286-3051
Practice Address - Fax:580-286-6960
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4822122300000X, 204E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies