Healthcare Provider Details

I. General information

NPI: 1801310990
Provider Name (Legal Business Name): GAIL TANKSLEY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 7TH AVE APT 2
NEW YORK NY
10030-2684
US

IV. Provider business mailing address

2266 FIFTH AVENUE PO BOX 523
NEW YORK NY
10037
US

V. Phone/Fax

Practice location:
  • Phone: 917-981-7113
  • Fax:
Mailing address:
  • Phone: 917-981-7113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number042089-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: