Individual
DR. RONALD DALE GAITROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
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
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
5707
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8993034
—
NC
01
—
93034
BLUE CROSS BLUE SHIELD #
NC
Enumeration date
10/10/2005
Last updated
01/07/2011
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