Provider Demographics
NPI:1871699082
Name:GARY L. DRURY, DDS, P.C.
Entity type:Organization
Organization Name:GARY L. DRURY, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRURY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-264-9015
Mailing Address - Street 1:810 W BRISTOL ST
Mailing Address - Street 2:SUITE ABC-1
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 W BRISTOL ST
Practice Address - Street 2:SUITE ABC-1
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2954
Practice Address - Country:US
Practice Address - Phone:574-264-9015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54000959A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental