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General NPI Number Information
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NPI Number | 1295333573
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Entity Type | Organization
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Legal Business Name | BRIAN P. GANLEY, DMD, PC
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 134 MAIN ST UNIT 1C
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City | GROTON
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State | MA
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Zip | 01450-1375
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Country | US
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Telephone | 978-448-5523
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 687
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City | GROTON
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State | MA
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Zip | 01450-0687
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. BRIAN PATRICK GANLEY
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Credential | DMD
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Telephone | 978-303-7916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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