MEDICARE: GARGANO FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	124Q00000X	Dental Hygienist
2	125J00000X	Dental Therapist
3	125K00000X	Advanced Practice Dental Therapist

General Provider Information

NPI Number	:	1508743022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARGANO FAMILY DENTISTRY

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

Provider Business Practice Location Address
First Line	:	21 WASHINGTON AVE STE 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	:	CREDENTIALING MANAGER
Name	:	NICOLE D HODGE
Credential	:
Telephone Number	:	347-523-2161

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/18/2025

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Directions to “GARGANO FAMILY DENTISTRY ” Practice Location

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