MEDICARE: DR. THEODORE GARGANO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11679	CT

General Provider Information

NPI Number	:	1114304490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE GARGANO DMD

Provider Business Mailing Address
First Line	:	21 WASHINGTON AVE UNIT A
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-2368
Country	:	US
Telephone Number	:	32-390-6782
Fax Number	:	203-239-3985

Provider Business Practice Location Address
First Line	:	21 WASHINGTON AVE UNIT A
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-2368
Country	:	US
Telephone Number	:	203-239-2356
Fax Number	:	203-239-3985

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	01/21/2019

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