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General NPI Number Information
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NPI Number | 1003835893
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Entity Type | Individual
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Provider Name | JOHN ROBERT GAGNE DDS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 390 MIDDLEBURY RD, SUITE 1
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City | MIDDLEBURY
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State | CT
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Zip | 06762
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Country | US
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Telephone | 203-755-9444
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Fax | 203-755-1552
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Provider Business Mailing Address
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Address Line | 390 MIDDLEBURY RD, SUITE 1
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City | MIDDLEBURY
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State | CT
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Zip | 06762
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Country | US
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Telephone | 203-755-9444
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Fax | 203-755-1552
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7680
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7680CT01
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License Number State | CT
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