Provider Demographics
NPI:1548284631
Name:GARY M EASLEY, DDS INC
Entity type:Organization
Organization Name:GARY M EASLEY, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:325-356-5263
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:203 VALLEY FORGE ST
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-0705
Mailing Address - Country:US
Mailing Address - Phone:325-356-5263
Mailing Address - Fax:325-356-2875
Practice Address - Street 1:203 VALLEY FORGE ST
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442
Practice Address - Country:US
Practice Address - Phone:325-356-5263
Practice Address - Fax:325-356-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD11,309OtherBCBS IDENTIFIER