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NPI Code Detail

MEDICARE: DR. GILDA J PRONYCH DDS

MEDICARE: DR. GILDA J PRONYCH DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry03186NH
21223G0001XGeneral Practice DentistryDEN3694ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538217724
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GILDA J PRONYCH DDS
Provider Business Mailing Address
First Line : 1 COLLEGE ST
Second Line :
City : PORTLAND
State : ME
Zip : 04103-2617
Country : US
Telephone Number : 207-221-4747
Fax Number :
Provider Business Practice Location Address
First Line : 1 COLLEGE ST
Second Line :
City : PORTLAND
State : ME
Zip : 04103-2617
Country : US
Telephone Number : 207-221-4747
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2007
Last Update Date : 07/22/2022

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