Organization
RONALD D. GAITROS, DDS, MS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD D. GAITROS DDS, MS (OFFICER/DIRECTOR)
(910) 762-2618
Entity
Organization
Contact information
Practice address
1122 MEDICAL CENTER DR, WILMINGTON, NC 28401-7305
(910) 762-2618
(910) 763-5173
Mailing address
1122 MEDICAL CENTER DR, WILMINGTON, NC 28401-7305
(910) 762-2618
(910) 763-5173
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5707
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145233
GUARDIAN
NC
01
—
733616
UCCI
NC
05
—
8993034
—
NC
01
—
93034
BCBS
NC
Enumeration date
04/01/2008
Last updated
04/24/2009
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