Healthcare Provider Details

I. General information

NPI: 1013975952
Provider Name (Legal Business Name): ROBERT S GILARDETTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 KINGSTOWN RD
WAKEFIELD RI
02879-3015
US

IV. Provider business mailing address

691 KINGSTOWN RD
WAKEFIELD RI
02879-3015
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-9758
  • Fax: 401-789-9763
Mailing address:
  • Phone: 401-789-9758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number152305
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: