Provider Demographics
NPI:1033594809
Name:GULLO DENTAL, PLLC
Entity Type:Organization
Organization Name:GULLO DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GULLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-394-4664
Mailing Address - Street 1:330 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1222
Mailing Address - Country:US
Mailing Address - Phone:585-394-4664
Mailing Address - Fax:585-394-0492
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1222
Practice Address - Country:US
Practice Address - Phone:585-394-4664
Practice Address - Fax:585-394-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048184122300000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty