Healthcare Provider Details

I. General information

NPI: 1821448176
Provider Name (Legal Business Name): MARIO GAGLIARDI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SUNSET BLVD
STEUBENVILLE OH
43952-1158
US

IV. Provider business mailing address

2700 SUNSET BLVD.
STEUBENVILLE OH
43952
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-6811
  • Fax:
Mailing address:
  • Phone: 740-264-6811
  • Fax: 740-264-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025194
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: