Healthcare Provider Details

I. General information

NPI: 1871717207
Provider Name (Legal Business Name): NOEL F GAIGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 STATE ROUTE 365
BARNEVELD NY
13304
US

IV. Provider business mailing address

PO BOX 441
BARNEVELD NY
13304-0441
US

V. Phone/Fax

Practice location:
  • Phone: 315-853-4488
  • Fax:
Mailing address:
  • Phone: 315-896-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number036762
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: