Provider Demographics
NPI:1366553695
Name:GARY G NAYLOR DDS PLLC
Entity type:Organization
Organization Name:GARY G NAYLOR DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:NAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-329-2682
Mailing Address - Street 1:RR 1 BOX 402
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-9715
Mailing Address - Country:US
Mailing Address - Phone:304-329-2682
Mailing Address - Fax:
Practice Address - Street 1:202 TUNNELTON ST STE 214
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1452
Practice Address - Country:US
Practice Address - Phone:304-329-1989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135772001Medicaid