Healthcare Provider Details

I. General information

NPI: 1497794341
Provider Name (Legal Business Name): GAYLE TUTONE MIRANDA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. GAIL TUTONE

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST DENTAL SERVICE 630/160
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

65 CENTRAL PARK W APT 10G
NEW YORK NY
10023-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-951-3255
  • Fax:
Mailing address:
  • Phone: 212-787-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number041863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: