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General NPI Number Information
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NPI Number | 1346306560
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Entity Type | Organization
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Legal Business Name | GARYLGIANGRECOPC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 2115 EMPIRE BLVD
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City | WEBSTER
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State | NY
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Zip | 14580-1907
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Country | US
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Telephone | 585-671-4522
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Fax | 585-617-1551
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Provider Business Mailing Address
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Address Line | 5 WAYBRIDGE CT
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City | PENFIELD
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State | NY
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Zip | 14526-9604
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Country | US
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Telephone | 585-545-5549
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Fax | 585-671-1551
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY L GIANGRECO
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Credential | DDS
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Telephone | 585-671-4522
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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 | 043501
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License Number State | NY
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