Provider Demographics
NPI:1528171097
Name:GEBHART, PAUL SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SCOTT
Last Name:GEBHART
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 1:26903 N 86TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3698
Mailing Address - Country:US
Mailing Address - Phone:623-322-3637
Mailing Address - Fax:480-419-9202
Practice Address - Street 1:21001 N TATUM BLVD STE 80-1690
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4206
Practice Address - Country:US
Practice Address - Phone:480-419-9200
Practice Address - Fax:480-419-9202
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD-61291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice