Healthcare Provider Details

I. General information

NPI: 1508743022
Provider Name (Legal Business Name): GARGANO FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WASHINGTON AVE STE A
NORTH HAVEN CT
06473-2368
US

IV. Provider business mailing address

21 WASHINGTON AVE STE A
NORTH HAVEN CT
06473-2368
US

V. Phone/Fax

Practice location:
  • Phone: 203-239-2356
  • Fax: 203-239-3985
Mailing address:
  • Phone: 203-239-2356
  • Fax: 203-239-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code125J00000X
TaxonomyDental Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code125K00000X
TaxonomyAdvanced Practice Dental Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE D HODGE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 347-523-2161