MEDICARE: DR. ALEC JAMES GANCI D.D.S.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1609142199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEC JAMES GANCI D.D.S.

Provider Business Mailing Address
First Line	:	127 E MAIN ST
Second Line	:	APT 201
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2840
Country	:	US
Telephone Number	:	516-524-3170
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 E MAIN ST
Second Line	:	APT 201
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2840
Country	:	US
Telephone Number	:	516-524-3170
Fax Number	:

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

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	03/28/2012

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