Healthcare Provider Details

I. General information

NPI: 1073362091
Provider Name (Legal Business Name): JERRY DONALD GARGANO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WASHINGTON AVE
NORTH HAVEN CT
06473-2368
US

IV. Provider business mailing address

21 WASHINGTON AVE
NORTH HAVEN CT
06473-2368
US

V. Phone/Fax

Practice location:
  • Phone: 203-239-2356
  • Fax:
Mailing address:
  • Phone: 203-997-7578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14222
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: