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General NPI Number Information
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NPI Number | 1225238041
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Entity Type | Individual
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Provider Name | GINO ANTHONY GISMONDI DDS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 02/03/2016
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Provider Practice Location Address
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Address Line | 700 W PIKE ST SUITE 100
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City | CLARKSBURG
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State | WV
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Zip | 26301-2696
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Country | US
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Telephone | 304-622-4828
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Fax | 304-624-0977
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Provider Business Mailing Address
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Address Line | 700 W PIKE ST SUITE 100
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City | CLARKSBURG
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State | WV
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Zip | 26301-2696
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Country | US
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Telephone | 304-622-4828
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Fax | 304-624-0977
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | WV3781
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 3781
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License Number State | WV
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