Healthcare Provider Details

I. General information

NPI: 1407846892
Provider Name (Legal Business Name): GREGORY J GAGLIARDI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 SECOND STREET PIKE
RICHBORO PA
18954
US

IV. Provider business mailing address

854 SECOND STREET PIKE
RICHBORO PA
18954
US

V. Phone/Fax

Practice location:
  • Phone: 215-355-3141
  • Fax: 215-355-3999
Mailing address:
  • Phone: 215-355-3141
  • Fax: 215-355-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS026956L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: