Provider Demographics
NPI:1144476813
Name:CONVEY, GAVIN (B DENT SC)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:
Last Name:CONVEY
Suffix:
Gender:M
Credentials:B DENT SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 NE 120TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5831
Mailing Address - Country:US
Mailing Address - Phone:425-326-7046
Mailing Address - Fax:
Practice Address - Street 1:11800 NE 128TH ST STE 540
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7208
Practice Address - Country:US
Practice Address - Phone:425-326-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250991223E0200X
WADE607172331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics