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General NPI Number Information
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NPI Number | 1508743022
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Entity Type | Organization
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Legal Business Name | GARGANO FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 21 WASHINGTON AVE STE A
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City | NORTH HAVEN
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State | CT
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Zip | 06473-2368
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Country | US
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Telephone | 203-239-2356
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Fax | 203-239-3985
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Provider Business Mailing Address
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Address Line | 21 WASHINGTON AVE STE A
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City | NORTH HAVEN
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State | CT
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Zip | 06473-2368
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Country | US
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Telephone | 203-239-2356
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Fax | 203-239-3985
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | NICOLE D HODGE
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Credential |
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Telephone | 347-523-2161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 125J00000X
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Taxonomy Name | Dental Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 125K00000X
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Taxonomy Name | Advanced Practice Dental Therapist
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License Number |
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License Number State |
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