Provider Demographics
NPI:1538366745
Name:GAWLEY, JEFFREY SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:GAWLEY
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 1:10618 COMBIE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8916
Mailing Address - Country:US
Mailing Address - Phone:530-268-0952
Mailing Address - Fax:833-287-5368
Practice Address - Street 1:10618 COMBIE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8916
Practice Address - Country:US
Practice Address - Phone:530-268-0952
Practice Address - Fax:833-287-5368
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice