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General NPI Number Information
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NPI Number | 1376856427
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Entity Type | Organization
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Legal Business Name | MARIANNA GAITSGORY, DMD, P.C.
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 55 MAIN ST UNIT 2
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City | FRAMINGHAM
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State | MA
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Zip | 01702-2934
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Country | US
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Telephone | 508-875-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 55 MAIN ST UNIT 2
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City | FRAMINGHAM
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State | MA
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Zip | 01702-2934
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Country | US
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Telephone | 508-875-0900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARIANNA GAITSGORY
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Credential | DMD
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Telephone | 508-875-0900
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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 | 20700
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License Number State | MA
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