Provider Demographics
NPI:1316323678
Name:GAZDECK, ROBERT KYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KYLE
Last Name:GAZDECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3709 UNIVERSITY DR STE D
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6224
Mailing Address - Country:US
Mailing Address - Phone:919-489-8661
Mailing Address - Fax:
Practice Address - Street 1:3709 UNIVERSITY DR STE D
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-489-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103081223P0700X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics