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General NPI Number Information
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NPI Number | 1871096172
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Entity Type | Organization
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Legal Business Name | DAVID GAMACHE
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 602 ROUTE 72 E
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-3504
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Country | US
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Telephone | 609-978-1111
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Fax | 609-597-1111
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Provider Business Mailing Address
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Address Line | 602 ROUTE 72 E
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-3504
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Country | US
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Telephone | 609-978-1111
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Fax | 609-597-1111
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID GAMACHE
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Credential | DDS
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Telephone | 609-597-1123
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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 | 15711
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License Number State | NJ
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