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General NPI Number Information
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NPI Number | 1275169211
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Entity Type | Individual
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Provider Name | DOMINIC GAMBINO DMD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2020
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 16 MAIN ST
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City | EAST HAVEN
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State | CT
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Zip | 06512-2506
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Country | US
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Telephone | 203-469-2711
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Fax |
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Provider Business Mailing Address
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Address Line | 140 TUNXIS VLG
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City | FARMINGTON
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State | CT
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Zip | 06032-1502
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Country | US
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Telephone | 203-233-1400
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Fax |
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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 | 13021
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License Number State | CT
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