Provider Demographics
NPI:1366101081
Name:GUSTAVO JR GASCA DMD PLLC
Entity type:Organization
Organization Name:GUSTAVO JR GASCA DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:GASCA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-756-6006
Mailing Address - Street 1:417 ARBORETUM DR STE 120
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-6305
Mailing Address - Country:US
Mailing Address - Phone:910-756-6006
Mailing Address - Fax:
Practice Address - Street 1:417 ARBORETUM DR STE 120
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-6305
Practice Address - Country:US
Practice Address - Phone:910-616-7632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty