Provider Demographics
NPI:1386717510
Name:GARY D OYSTER DDS PA
Entity type:Organization
Organization Name:GARY D OYSTER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:OYSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-876-2087
Mailing Address - Street 1:4901 LEIGH DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616
Mailing Address - Country:US
Mailing Address - Phone:919-876-2087
Mailing Address - Fax:919-981-0382
Practice Address - Street 1:4901 LEIGH DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616
Practice Address - Country:US
Practice Address - Phone:919-876-2087
Practice Address - Fax:919-981-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
419149OtherUNITED CONCORDIA
NC8996572Medicaid