Provider Demographics
NPI:1154474377
Name:STARBUCK, GARY WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
Last Name:STARBUCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BAYVIEW ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6993
Mailing Address - Country:US
Mailing Address - Phone:207-846-9657
Mailing Address - Fax:207-846-5266
Practice Address - Street 1:70 BAYVIEW ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6993
Practice Address - Country:US
Practice Address - Phone:207-846-9657
Practice Address - Fax:207-846-5266
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME23291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice