Healthcare Provider Details

I. General information

NPI: 1891865655
Provider Name (Legal Business Name): VIRGINIA E GAVRIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 ELLIOT ST SUITE 195L
NEWTON UPPER FALLS MA
02464-1157
US

IV. Provider business mailing address

381 ELLIOT ST SUITE 195L
NEWTON UPPER FALLS MA
02464-1157
US

V. Phone/Fax

Practice location:
  • Phone: 617-527-0880
  • Fax: 617-964-2229
Mailing address:
  • Phone: 617-527-0880
  • Fax: 617-964-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. VIRGINIA GAVRIS
Title or Position: PRESIDENT
Credential:
Phone: 617-527-0880