Healthcare Provider Details

I. General information

NPI: 1356366165
Provider Name (Legal Business Name): DANTE E GULINO JR. DDS., MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 GOLD STAR HWY SUITE 205
GROTON CT
06340-6228
US

IV. Provider business mailing address

495 ROUTE 184 SUITE 205
GROTON CT
06340
US

V. Phone/Fax

Practice location:
  • Phone: 860-449-1023
  • Fax:
Mailing address:
  • Phone: 860-449-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number008353
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: