Provider Demographics
NPI:1932253341
Name:RICHARD WAYNE GILREATH,DDS,PA
Entity type:Organization
Organization Name:RICHARD WAYNE GILREATH,DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GILREATH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-786-8334
Mailing Address - Street 1:1142 S SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5332
Mailing Address - Country:US
Mailing Address - Phone:336-786-8334
Mailing Address - Fax:336-786-8250
Practice Address - Street 1:1142 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5332
Practice Address - Country:US
Practice Address - Phone:336-786-8334
Practice Address - Fax:336-786-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6035261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC281989OtherANTHEM
NC764612OtherUNITED CONCORDIA
NC8993193Medicaid
NC281OtherTRIGON
NC93193OtherBLUE CROSSBLUE SHIELD
19784Medicare UPIN