Healthcare Provider Details

I. General information

NPI: 1730276510
Provider Name (Legal Business Name): GENEVIEVE GAGNON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 ALLING STREET DENTAL HEALTH ASSOCIATES PA
NEWARK NJ
07102
US

IV. Provider business mailing address

320 SOUTH MAIN STREET CORPORATE OFFICE 2ND FLR
PHILIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 973-297-1550
  • Fax: 973-297-1554
Mailing address:
  • Phone: 908-387-6120
  • Fax: 908-387-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDI022118
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: