Healthcare Provider Details

I. General information

NPI: 1346254349
Provider Name (Legal Business Name): GINO G SAPONARI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PROFESSIONAL CT
ELBERTON GA
30635-1824
US

IV. Provider business mailing address

2 PROFESSIONAL CT
ELBERTON GA
30635-1824
US

V. Phone/Fax

Practice location:
  • Phone: 706-283-3505
  • Fax: 706-283-3512
Mailing address:
  • Phone: 706-283-3505
  • Fax: 706-283-3512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number011570
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: