Provider Demographics
NPI:1144308586
Name:ANDREW M. GAST, D.D.S., INC.
Entity type:Organization
Organization Name:ANDREW M. GAST, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-522-1837
Mailing Address - Street 1:1 MARION AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-7905
Mailing Address - Country:US
Mailing Address - Phone:419-522-1837
Mailing Address - Fax:419-526-3927
Practice Address - Street 1:1 MARION AVE STE 201
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-7905
Practice Address - Country:US
Practice Address - Phone:419-522-1837
Practice Address - Fax:419-526-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH195711223G0001X
126471223P0300X
OH210531223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty